Beta-blocker combinations for raised BP questioned
Coronary events were reduced by the newer treatment strategy |
Serious doubts have been raised over the use of beta-blocker and diuretic combinations in hypertension by data from a huge UK study.
The trial, involving almost 20,000 patients, compared a newer ACE inhibitor/calcium
channel blocker combination with the more traditional combination.It
found the newer treatment strategy was associated with a 24 per cent
relative risk reduction in cardiovascular mortality (P<0.0001).The
older combination was also associated with a 32 per cent increased risk
of developing diabetes (P<0.0001).
The data from ASCOT-BPLA (The Anglo-Scandinavian Cardiac Outcomes Trial:
Morbidity-Mortality Outcomes in the Blood Pressure-Lowering Arm) were
presented this week at the American
College of Cardiology meeting.The
trial involved 19,257 patients with hypertension aged 40–79, randomised
to receive the older combination of atenolol with or without bendroflumethiazide
or the calcium channel blocker amlodipine with or without the ACE inhibitor
perindopril.
The reduction in stroke, coronary events, CV death and all-case mortality
with the newer treatment was so great that the data safety and monitoring
board ordered the trial be stopped early.
“These data raise serious questions over the continued use of beta-blocker
containing combinations in uncomplicated hypertension,” said Peter
Sever, chairman of ASCOT and professor of clinical pharmacology and therapeutics
at Imperial College London.
The full data set will be published later this year. Although these results
are from about 95 per cent of the data, Professor Sever said the final
figures are unlikely to change very much. |
The
Pharmaceutical Journal
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