The results of a randomised trial, published in The Lancet, demonstrated that a combination of modern anti-hypertensive drugs can reduce a patients risk of stroke and heart attack to a greater extent than standard treatments.
Hypertension is the most important preventable cause of premature death in developed countries, and the benefits of antihypertensive drugs for prevention of cardiovascular mortality and morbidity are well established.
However, no individual trial using standard diuretic or beta-blocker therapy, or both has shown a significant reduction in coronary heart disease.
Previous studies have suggested that newer agents would confer advantages over diuretics and beta-blockers.
In the Anglo-Scandinavian Cardiac Outcomes Trial ( ASCOT ), Bjorn Dahlof , from Sahlgrenska University Hospital, Sweden, and colleagues compared the effect of combinations of older drugs - Atenolol ( Ternomin ) and Thiazide - with newer drugs, Amlodipine ( Norvasc ) and Perindopril ( Aceon ).
The investigators recruited 19257 patients aged between 4079 years who had a least three other risk factors for cardiovascular events. Half of the patients were assigned the Atenolol-based regimen and half the Amlodipine-based regimen.
After 5 years the investigators found those allocated the Amlodipine-based regimen had lower blood pressure values than those on the Atenolol-based regimen.
They also found that the newer drugs prevented more major cardiovascular events and caused fewer cases of diabetes than the older drugs.
Dahlof comments: The preferential reduction in cardiovascular events associated with an antihypertensive regimen of a calcium-channel blocker, Amlodipine, with addition of Perindopril if necessary, particularly when used in combination with effective lipid lowering, results in the prevention of most major cardiovascular events associated with hypertension. We hope these results will be used to inform clinical practice in ways that should greatly reduce the burden of cardiovascular disease to which patients with hypertension are exposed.
Source: The Lancet, 2005