Newer BP Pill Cuts Risk of Strok, Diabetes

[Guest guest]

IN THE STUDY, people who took Cozaar were 25 percent less likely to suffer a stroke and 25 percent less likely to develop diabetes, compared with those given a standard blood-pressure-lowering pill known as atenolol. But blood pressure dropped equally in both groups. And in patients who already had diabetes at the start of the trial — a group that is notoriously difficult to treat — the risk of dying was nearly 40 percent lower in the Cozaar-treated group, reported chief investigator Dr. Bjorn Dahlof, an associate professor of medicine at Goteborg University in Goteborg, Sweden. The trial enrolled 9,193 people in whom longstanding high blood pressure had thickened their heart muscle, weakening its ability to contract and pump blood — a condition doctors call left ventricular hypertrophy, or LVH. About half received Cozaar, known generically as losartan, and the rest, atenolol, sometimes sold under the brand name Tenormin. MAJOR IMPLICATIONS If all of the 3.9 million Americans over 55 with high blood pressure and LVH who were candidates for Cozaar were given the drug, 66,000 strokes and 54,000 new cases of diabetes would be prevented each year, Dahlof said.

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“We knew it mattered to lower blood pressure [in these patients],” Dahlof said. “Now we know it matters how we lower blood pressure. “This has immediate applications for clinical practice,” he said. Other heart doctors agreed the results could change the standard of care for many patients with high blood pressure. “This is a tremendous trial,” said Dr. Holmes, Jr., a cardiologist at the Mayo Clinic in Rochester, Minn. Holmes was moderator of the session at which the results were presented to a loud round of applause from heart doctors meeting here for the American College of Cardiology’s Scientific Sessions.

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Category

Systolic (mm Hg)

Diastolic (mm Hg)

Optimal blood pressure

Lower than 120

Lower than 80

Normal blood pressure

Lower than 130

Lower than 85

High-normal blood pressure

130-139

85-89

Hypertension

Stage 1 (mild)

140-159

90-99

Stage 2 (moderate)

160-179

100-109

Stage 3 (severe)

180 or higher

110 or higher

* Classifications for those 18 and older. Blood pressure is expressed in two numbers that represent the systolic pressure (when heart contracts and is pumping blood) over diastolic pressure (when heart is at rest). These numbers are measurements of millimeters (mm) of mercury (Hg). When systolic and diastolic blood pressures fall into different categories, the higher category should be selected to classify blood pressure status.

STUDY DETAILS In the study, patients were randomly assigned to receive either Cozaar or atenolol once a day. If needed, they could take other heart drugs such as diuretics. Among other findings of the five-year study, which will also be published in this week’s issue of The Lancet: There were 232 fatal and non-fatal strokes in the group treated with Cozaar, compared with 309 in the atenolol group. Cozaar significantly reduced LVH, compared to atenolol, as shown on yearly electrical tracings of the heart. There were 241 new cases of diabetes among patients treated with Cozaar and 319 new cases in the atenolol-treated patients. Of the 1,195 patients who had diabetes when the study started, Cozaar significantly reduced the risk of death by 39 percent, compared to patients treated with atenolol. Sixty-three patients on Cozaar died versus 104 on atenolol. A small percentage of people taking Cozaar complain of upper respiratory tract infections, dizziness and leg pain. Side effects from atenolol, too, are generally mild: fast heart beat, dizziness and nausea in a few patients. Charlene Laino is MSNBC Health Editor.