Combination of Medicines May Be Best for Blood Pressure Cont

Combination of Medicines May Be Best for Blood Pressure Control: Presented at ASH

CHICAGO, IL -- May 29, 2007 -- Millions of Americans take medications
for hypertension but do not achieve control of their blood pressure.
Single-tablet combinations of drugs may be what it takes to get blood
pressure under control, even in people with moderate hypertension,
according to results from a new international study involving more than
10,700 people with high blood pressure.



Eighteen-month data was presented here at the American Society of
Hypertension (ASH) meeting. The six-month data are published
simultaneously in the journal Blood Pressure.



Just six months of treatment was enough to bring the blood pressure of
73% of patients into an acceptable range, with an average reading of
132/74 mm Hg. That's a near-doubling of the proportion that started the
study with their hypertension under control -- despite the fact that
nearly all patients came into the study on other medication before
switching to one of the two-drug combinations used in the study.



After 18 months of treatment, patients continued to have good blood
pressure control. In fact, more than 80% of participants from the
United States achieved control, with a mean systolic blood pressure of
129 mm Hg. This is exceptional news in that only 36% of study subjects
in the U.S. treated by clinicians achieve a blood pressure of 140/90.



The news was also good among people with diabetes or kidney disease --
who need to aim for lower blood pressures than others in order to
reduce their risk of heart disease and stroke, but who often have a
harder time getting their BP down. People with diabetes in the study
achieved a mean systolic BP of 131 mm Hg while those with chronic
kidney disease were at 136 mm Hg. These groups also saw sustained blood
pressure control.



There were few side effects in the study volunteers, despite the fact
that doses were increased steadily. Only 1.8% of patients had an
episode where their blood pressure dropped too low -- a potential
effect of aggressive BP treatment.



"These data suggest strongly that single tablets containing two drugs
will control the vast majority of patients who are taking medication
but have not achieved ideal blood pressure. These data may affect the
blood pressure control of over 38 million Americans," says study leader
and lead author Ken Jamerson, MD, a professor of cardiovascular
medicine at the University of Michigan Medical School and member of the
U-M Cardiovascular Center.



The goal of the ACCOMPLISH study, begun in 2003 and funded by Novartis,
is to compare the impact of two different two-drug combinations on the
long-term health of a global sample of people with hypertension.
Novartis markets single-pill forms of both two-drug products, but they
are also available separately as individual drugs.



The trial randomly assigned patients to one of two drug combinations.
Both combinations contained a drug called benazepril, which belongs to
a class of medicines known as ACE inhibitors. The other drug in one of
the combinations is a diuretic called hydrochlorothiazide; in the other
combination pill, it's a drug called amlodipine, one of a class of
medicines called calcium channel blockers.



It is too early to say if one of the combinations surpasses the other
in bringing blood pressure down or in preventing cardiovascular
problems and death.



But because many studies have already shown that reducing blood
pressure can reduce the risk of stroke, heart attack, heart failure and
other conditions, achieving blood pressure control in large percentages
of high-risk people is an accomplishment in itself, says Jamerson.



Currently, blood pressure treatment guidelines call for a single
medicine to be tried first in people with Stage 1 hypertension -- those
with the top, or systolic, reading over 140 and the bottom, or
diastolic, reading over 90, but with readings less than 160 systolic
and 100 diastolic.



As many as 60 million Americans have high blood pressure. But because
high BP doesn't cause symptoms, most people who have it don't know it.
Over time, uncontrolled blood pressure affects the blood vessel walls,
encouraging the growth of weak spots called aneurysms and the formation
of narrowed and inflamed areas that can lead to clots that can break
off and cause heart attacks and strokes.



Only 30% of Americans who have high blood pressure, and only 60% of
those taking medicines for hypertension, currently have their blood
pressure under control. Fortunately, once the condition is diagnosed,
doctors have a broad range of medicines to choose from to try to get it
under control, including many inexpensive generic medicines. But
studies have found that patients often have trouble taking the multiple
medications they need. As a result, many companies have developed
combination pills. The ACCOMPLISH data suggest these combination
tablets have the potential to improve control rates to over 80%.



ACCOMPLISH stands for Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension.