Date:
03/31/2008 10:33 PM Blood pressure drugs can prevent heart attacks and
stroke, even in the very old, studies find
By MARILYNN MARCHIONE
AP Medical Writer
CHICAGO (AP) _ Two big studies offer good
news to people with high blood pressure, finding that novel
ways to use cheap drugs already on the market can lower their
risk of heart attacks, stroke and death — even if they
are very old.
Both studies were stopped early so the surprising
benefits could be made known. Doctors presented results Monday
at an American College of Cardiology conference in Chicago.
"It is never too late to start"
on blood pressure drugs, said Dr. Nigel Beckett of Imperial
College in London, who led one study in the elderly that also
was published online by the New England Journal of Medicine.
More than 70 million Americans have high blood
pressure — readings of 140 over 90 or more — and
only a third have it well controlled by medicines. Guidelines
advise starting on one, usually a "water pill,"
and adding others as needed.
With each new medication, "You get more
pills, more copays," said Dr. Kenneth Jamerson of the
University of Michigan. "Our idea is, if you have to
add on, why not do two right off the bat" in a single
pill.
He led a study testing a single daily pill
combining a diuretic and the ACE inhibitor benazepril versus
a daily pill containing benazepril and a calcium channel blocker,
amlodipine. ACE inhibitors dilate blood vessels to lower pressure.
Calcium channel blockers do the same in a different way.
A total of 11,462 people in the United States
and Nordic countries were given one combo or the other. Their
average age was 68, and besides high blood pressure they were
obese, had diabetes or other health problems.
Neither they nor their doctors knew which
drugs they were taking until the study was stopped in October
after it was clear that people on the ACE-calcium blocker
combo were doing better.
Those people had about 20 percent fewer heart-related
problems or strokes — 526 among the 5,713 in this group
versus 650 events among the 5,732 others, Jamerson said.
The study was paid for by Novartis, which
sells Lotrel, the combo that proved better, and Jamerson consults
for the company. The drugs are all sold as generics, although
the doses in some require two pills a day instead of one.
The findings could shape treatment guidelines
due to be reviewed in a few months, said Dr. Daniel Jones,
a University of Mississippi blood pressure specialist and
president of the American Heart Association.
Doctors can start with a combination, but
few do, partly for lack of evidence, he said.
Guidelines also may change to reflect a second
study that found dramatic benefits for treating people in
their 80s, an age when blood pressure drugs were not known
to be safe or effective.
"The over-80s are the most rapidly expanding
segment of our population," and the prevalence of blood
pressure rises as people age, Beckett noted.
His study assigned 3,845 older people in Europe,
China and several other countries to take the diuretic indapamide
or dummy pills plus the ACE inhibitor perindopril as needed
to reach a goal of 150/80 from an average starting pressure
of 173/91.
The study was stopped last July after monitors
saw that those on the diuretic had 39 percent fewer fatal
strokes and 21 percent fewer deaths from any cause —
benefits far exceeding what researchers predicted.
Jones called it one of the most important
studies at the cardiology meeting and a key advance for older
people. The study did not include frail older people in nursing
homes, who might reap less benefit than healthier people,
doctors noted.
Also at the conference:
— The diabetes drug Actos shrunk artery
buildups that can lead to heart disease when tested against
glimepiride, an older diabetes drug, in a study of 360 diabetics
led by Cleveland Clinic cardiologist Steven Nissen.
"This is the first time in which a diabetes
therapy has been shown to slow or prevent" heart disease,
he said. Results were published online by the Journal of the
American Medical Association.
— A combined analysis of six studies
on Celebrex, the only COX-2 inhibitor painkiller still on
the market since the withdrawal of Vioxx, gives reassurance
of the drug's relative safety for people who do not have big
heart disease risk factors when they start taking the drug.
It tested doses used by people with rheumatoid
arthritis and other severe chronic pain — roughly double
the levels used by people with more common osteoarthritis.
The federally funded study was published in
the journal Circulation.
"It gives me some comfort" about
the safety of Celebrex, said Nissen, who is leading a larger
study of the Pfizer Inc. drug and other painkillers.
