JADN home page JADN Repository home page Wonder drug cocktail for high blood pressure

Taking Coversyl (perindopril) and amlodipine together is more effective than a single drug
From an article published in September 2005

A major study has revealed that the lives of thousands of patients with high blood pressure could be saved every year by taking a combination of two drugs. Charlotte Harding takes a detailed look at Coversyl and amlodipine, and assesses whom they might benefit.

Why have these drugs hit the headlines?

The largest ever European study into high blood pressure has found that Coversyl and amlodipine are far more effective than the drugs traditionally used to treat the condition. The study, called the Anglo-Scandinavian Cardiac Outcomes Trial, found that if just half of the seven million British people treated for high blood pressure were put onto the drugs there would be 35,000 fewer deaths from heart disease over five years. There would also be almost 40,000 fewer strokes and 100,000 fewer cardiovascular incidents such as heart attacks and angina.

The study also concluded that about 90,000 fewer patients would develop diabetes. The trial involved 9,000 British patients aged 40 to 79 over five years. Half were given the new drug combination, the rest were given traditional drugs. Coversyl and amlodipine were found to be so effective that the trial was stopped early so that all patients could receive them. The study also found that if patients were given cholesterol lowering drugs called statins in addition to the new drugs their risks of heart attacks and strokes were cut even further.

Why are the latest findings so important?

High blood pressure is the leading preventable cause of premature death in the developed world. Sixteen million people in Britain are thought to suffer from the condition although eight million are unaware of it.

The condition causes two-thirds of heart attacks and 40 per cent of strokes. Only 10% of patients who receive treatment for the condition are thought to have it effectively under control. The results of the latest study may well change the way that GPs treat high blood pressure in the future.

Which drugs are traditionally used to treat the condition?

The traditional treatments for high blood pressure are beta blockers and diuretics. Beta blockers work by modulating the heart’s rhythm — slowing it down and reducing its need for blood and oxygen. Diuretics, also known as water tablets, increase the need for urination, which increases the amount of salt expelled by the body. As salt is one of the main causes of high blood pressure, this helps to lower it.

How do Coversyl and amlodipine differ?

Coversyl is a member of the ACE inhibitor class of blood pressure lowering drugs, which lower blood pressure by causing relaxation of the blood vessel walls. Coversyl is an effective ACE inhibitor as it can reduce blood pressure coming directly from the heart as well as blood pressure in the limbs.

Amlodipine is a calcium channel blocker, which also relaxes blood vessel walls. Because they relax these walls, but in different ways, they are powerful together.

A survey by the Blood Pressure Society earlier this year also found that patients suffer fewer side effects with the new drugs. Many patients complain that beta blockers cause lethargy, tiredness and impotence.

How long have the drugs been on the market?

The 2mg and 4mg Coversyl tablets were launched in the UK in 1989 and the 8mg dose in 2002. Amlodipine has been available in Britain since 1990.

How widely used are the newer drugs?

Coversyl, also known as perindopril, and amlodipine, also known as Istin, are licensed for use in Britain. Most patients take more than one treatment for blood pressure. The majority take at least one older treatment, and patients could benefit by switching to the new drugs.

When might they become more widely available?

The Government’s drug rationing body, the National Institute of Clinical Excellence, and the British Hypertension Society, have agreed to discuss the findings urgently with a view to updating their advice on blood pressure medication within six months.

How much would the new drugs cost the NHS?

A detailed economic analysis of the drugs is expected —perhaps before the end of the year. Although the newer drugs are more expensive, these costs may be offset by fewer admissions for heart attacks, strokes, bypasses and diabetes. Some estimate the new drugs could end up saving the NHS millions of pounds.

Do you need to worry if taking traditional drugs?

No. The Blood Pressure Association warns that patients prescribed older drugs should keep taking them until their GP advises them otherwise, as they remain effective. Ending a treatment suddenly is dangerous. The association advises discussing the new drugs with a GP at your next appointment.

How many people are also taking statins?

About a quarter of blood pressure patients also take cholesterol-lowering statins. These were found in the trial to further enhance the benefits of the new blood pressure drugs. The Blood Pressure Association supports their wider use among blood pressure patients, and advises patients to discuss the possibility of taking these drugs in addition to their blood pressure medication at their next GP appointment.

Valid HTML 4.01 Transitional