Drug Combos Best for Controlling Blood Pressure

Lowering cholesterol also offers benefits, studies find

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By Steven Reinberg
HealthDay Reporter

SATURDAY, May 20, 2006 (HealthDay News) -- Patients being treated for high blood pressure have a better chance of reaching their blood pressure goals by taking a combination of medications, and may achieve additional benefit by lowering their cholesterol.

That's the conclusion of three studies presented Friday at the American Society of Hypertension's annual meeting, in New York City.

In the first study, Dr. Paul M. Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston, presented findings from the Val-MARC trial.

In the trial, 1,668 patients who had severe high blood pressure were treated with either the antihypertension drug valsartan alone or in combination with a diuretic. Valsartan is a drug known as a angiotensin receptor blocker.

"It was not surprising that the combination therapy was more effective," Ridker said. After six weeks of treatment, Ridker's team found the patients receiving both drugs had an average drop in blood pressure of 25 mmHg, compared with a drop of 18 mmHg among those receiving valsartan alone.

The study was also designed to gauge whether lowering blood pressure also lowered C-reactive protein (CRP), a marker of inflammation that has been associated with an increased risk of heart attack.

The researchers found that those patients taking valsartan alone had a 9 percent drop in the blood levels of CRP, but those taking the diuretic as well showed no drop in CRP. "This was an unanticipated finding," Ridker said. "There is no relationship whatsoever in the extent of blood pressure reduction and the extent of CRP reduction."

"These findings suggest that valsartan may reduce inflammation independently from blood pressure reduction," Ridker said. "These findings are an important confirmation of recent recommendations of the superiority of combination hypertension therapy in terms of reaching target blood pressure goals."

In the second study, researchers found that giving the antihypertensive drug amlodipine to diabetic patients who had high blood pressure and were taking a single drug to control it, produced much better blood pressure control.

In the study, called the Amlodipine Diabetic Hypertension Efficacy Response (ADHT), the researchers treated 411 patients with a combination of amlodipine and losartan or quinapril, or amlodipine plus a placebo.

The researchers found that more patients with diabetes (27.5 percent) receiving the combination of drugs were able to achieve their blood pressure goal, regardless of the severity of their blood pressure. This compared with 12.5 percent of the patients taking only one drug.

"This study confirms that the use of combination therapy in the management of hypertension is critically important," said study presenter Dr. Joel Neutel, from the Orange County Heart Institute and Research Center, in California. "To get more diabetic patients to their blood pressure goal, you need four or five drugs."

In the third study, Dr. John B. Kostis, chairman of the department of medicine at the Robert Wood Johnson Medical School in New Jersey, and his colleagues showed that lowering blood pressure and cholesterol among patients with coronary artery disease significantly reduced rates of heart attack and stroke.

In the study, Kostis' team collected data on 9,739 people. The researchers found that as blood pressure and cholesterol dropped, the rate of heart attacks and strokes fell from 11.1 percent of the patients to 7.1 percent.

Both cholesterol and blood pressure levels can help predict the chances of major cardiovascular events, Kostis said. "The lowest events occurred among patients with the lowest cholesterol and the lowest blood pressure. Therefore the effective management of both would result in the best outcome for these patients," he said.

More information

The American Heart Association can tell you more about high blood pressure.

SOURCES: Paul M. Ridker, M.D., director, Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston; Joel Neutel, M.D., Orange County Heart Institute and Research Center, Orange, Calif.; John B. Kostis, M.D., chairman, department of medicine, Robert Wood Johnson Medical School, New Brunswick, N.J.; May 19, 2006, presentations, American Society of Hypertension annual meeting, New York City

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