Pressure on hypertension meds rises

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Chris Kaiser, Editor
While many studies continue to evaluate the current crop of statins and angiotensin-converting enzyme (ACE) inhibitors, some researchers have their eyes on the next generation of combination therapies using these two classes of drugs.

Dr. R. James Dudl, at Kaiser Permanente, and colleagues published positive results in the American Journal of Managed Care regarding combination therapy of aspirin, statin and an ACE inhibitor. The research examined more than 170,000 patients with coronary artery disease or over the age of 55 and diagnosed with diabetes.

There was a linear reduction in MI and stroke corresponding to the rate of drug exposure: high, low and no exposure. Those in the high-exposure group had a 26 percent reduction in MI and stroke, compared with the other two groups.

The authors concluded that “preventing adverse cardiovascular events among populations at risk is a pressing, ongoing need and developing next-generation statins and ACE inhibitors consumes substantial resources.”

In more blood pressure medication news, researchers from the University of Connecticut published in the Annals of Internal Medicine findings that ACE inhibitors and angiotensin receptor blockers (ARBs) can effectively treat stable ischemic heart disease.

The meta-analysis from 41 studies, led by Dr. William L. Baker, found strong evidence in favor of ACE inhibitors (32,000 patients) to reduce mortality and nonfatal MI.

The evidence for ARBs was not as robust as that for ACE inhibitors, but researchers found low-strength evidence (6,000 patients) that ARBs reduce mortality and nonfatal MI. Both classes of drugs increase the risk of syncope, cough or hypotension.

The evidence for ARBs may be forthcoming as the FDA this month approved telmisartan to reduce MI or stroke in certain patients who are unable to take ACE inhibitors. Boehringer, makers of telmisartan, also received FDA approval for Twynsta, a combination of telmisartan and amlodipine (calcium channel blocker) to treat hypertension. Twynsta is not approved for reducing cardiovascular events.

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Chris Kaiser, Editor