New blood pressure-lowering drugs reduce stroke risk by 50%

Sep 5 2005

According to researchers the new types of blood pressure-lowering drugs are more effective in preventing strokes and heart attacks and save even more lives.

Patients with high blood pressure taking a relatively new type of cholesterol-lowering medication called a statin benefited from a 36% reduction in heart attacks and a 27% reduction in strokes compared to those not prescribed that specific medication.

Overall, the risk of death from strokes and heart attacks was reduced by 24% with the newer drugs compared with the older ones.

Hypertension is one of the most important preventable cause of premature death in developed countries, and the benefits of antihypertensive drugs is well established.

However, although previous studies have suggested that newer agents might have advantages over diuretics and Beta-blockers, to date no individual trial using those therapies has shown a significant reduction in coronary heart disease.

Now a new major trial by researchers, from the UK and Scandinavia, says their results will provide reassurance and guidance for doctors and patients alike.

In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), Bjorn Dahlof of Sahlgrenska University Hospital, in Sweden, and colleagues compared the effect of combinations of older drugs - atenolol and thiazide - with newer drugs, amlodipine and perindopril.

In the study the investigators recruited 19257 patients aged between 40–79 years who had a least three other risk factors for cardiovascular events, half were prescribed the atenololbased regimen and half the amlodipine-based regimen.

The researchers found after 5 years that those on 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.

These cholesterol-lowering findings were discovered back in 2002 - five years after the planned 10-year trial began in 1997, and the trial was stopped early because the results were so outstanding.

The researchers continued to compare the blood pressure effects, but terminated this part of the study early as well last December after it became clear that the newer antihypertensive drugs were also better at lowering blood pressure.

Neil Poulter of Imperial College London, and colleagues also, in a second study, looked at differences in blood pressure and other variables in patients assigned the newer drugs as against those allocated the standard drugs.

They found that a reduction in blood pressure was the single biggest contributor to the effect on stroke events, but other factors, such as differences in cholesterol, were more important for coronary events.

The latest report which is published in the Lancet is the first time that the researchers have combined together all of their results.

Dr Dahlof says they hope the 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.

Experts believe prescribing practices should change immediately based on the Ascot study's conclusions, as the new drugs not only lower blood pressure to a greater extent than older ones, but also attack cholesterol, reducing by half the stroke and heart attack risk.