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Two new
studies reported in this week's Lancet have found that the
new generation angiotensin II receptor blocking drug losartan
is more effective than one of the highly utilized beta-blockers
in reducing the incidence of stroke and death that can occur
in people with high blood pressure.
Beta-blockers
and diuretics have long been recognized as the most effective
treatment to prevent cardiovascular illness and death in patients
with high blood pressure. The new findings should increase
the use of the newer drugs.
"It's
rare in hypertension that you get a block buster," Dr.
Michael Weber, past president of the American Society of Hypertension,
told Medical Week. "It seems like every four or five
years one comes along that will really affects how we treat
this disease. This is big news. I do believe there will be
a switch."
"We
live in an era of direct to consumer advertising," Weber
continued. "Doctors are constantly being accosted by
patients who want to use certain drugs. So the doctors are
being pretty much inured to the situation. But this is better
than direct-to-consumer advertising. It is based on a landmark
clinical trial that will really affect the guidelines. We
have a responsibility to let patients know."
While
doctors may stand pat on their use of beta-blockers in patients
that have responded really well to such drugs, Weber said
those treating higher risk patients with co-morbidities are
obligated to think seriously about making the switch to losartan
or a similar drug in that class.
In one
of the studies, Bjorn Dahlof, of Ostra University Hospital
in Sweden, and his colleagues looked at 9,200 hypertensive
patients to determine whether losartan or the beta-blocker
atenolol is better for those with high blood pressure. Each
of the participants was given either losartan-based or atenolol-based
antihypertensive treatment.
Although
the reduction in blood pressure was similar for both treatments,
losartan reduced the overall risk of cardiovascular death,
stroke and heart attack by around 25 percent. The researchers
also found that the drug reduced stroke by 25 percent compared
with just seven percent for the beta-blocker atenolol.
In the
other study, Lars Hjalmar Lindholm, of Umea University in
Sweden, and his colleagues compared the efficacy of losartan
and atenolol in about 1,200 patients who had diabetes in addition
to hypertension. They found that losartan reduced the risk
of cardiovascular death, stroke and heart attack by around
25 percent, the risk of cardiovascular death by 37 percent
and the risk of death from all causes by 40 percent.
In an
accompanying commentary about the studies, Hans Brunner, of
CHUV, in Lausanne, Switzerland, said the studies indicate
that the combination of an angiotensin-renin blocker like
losartan in combination with low-dose hydrochlorothiazide
provides at least equal cardioprotection to beta blockers
and more protection from strokes with the further benefit
of fewer side effects.
He said
the trials add one more piece of evidence to support the claim
that angiotensin II is an important risk factor in cardiovascular
disease.
Source:
Hypertension
Week of March 24, 2002
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