The way that high blood pressure is treated should be radically changed in order to produce better and faster results, potentially cutting numbers of strokes, according to researchers.
A study published in The Lancet medical journal today, suggests that the current “start low, go slow” approach should be replaced and that patients should be given two drugs in combination from the start.
Doctors usually start with one drug and then add others as required to control blood pressure, in order to minimise side-effects. But this is not the speediest and most effective way of treating high blood pressure, the study has shown, and delays the protective effect that treatment can have against stroke.
The research, led by Cambridge University in collaboration with the Universities of Dundee and Glasgow and the British Hypertension Society, could change the way that millions of people across the UK are medicated.
High blood pressure, or hypertension, affects around 10 million people in the UK – around one in three adults. Left untreated, it increases the risk of heart disease and stroke, two of Scotland’s biggest killers.
The ACCELERATE study of 1,250 patients with hypertension shows that a new way of treating patients lowers blood pressure faster and more effectively, with fewer side-effects than conventional treatment.
The researchers found that patients who start treatment with a single tablet containing a combination of two drugs will have a 25 per cent better response during the first six months than those receiving conventional treatment, and are less likely to stop treatment because of side-effects.
The blood pressure in the research cohort given conventional treatment did not catch up with the other group, even when all the patients in the study were being treated with the same combination of drugs.
The researchers believe that starting with one drug allows the body to neutralise it, partially, but hitting the body harder and faster prevents this from happening.
Professor Morris Brown, of the University of Cambridge and Addenbrooke’s Hospital, said, “The ACCELERATE study breaks the mould for treating hypertension. Most patients can now be prescribed a single combination pill and know that they are optimally protected from strokes and heart attacks.”
Professor Tom MacDonald, of the University of Dundee, said: “The research is a great result for patients with high blood pressure. Starting with two medicines is clearly better than starting with one and amazingly there were fewer side effects and not more.”
The study was designed by the British Hypertension Society and was conducted in partnership with the pharmaceutical company Novartis. This allowed the treatment programme to be tested in ten countries on four continents.
The British Heart Foundation is now funding a similar study with different medicines to ensure that these results are generalisable and not just applicable to the drugs tested.
Prof Brown explained that the collaboration with Novartis was formed because it was “no longer possible to undertake such a trial expeditiously in the UK”. He added: “Indeed, we mention in our paper that our replication study funded by the BHF is not due to finish until 2013 at the earliest. It took almost two years to obtain regulatory approval for all sites.”
Meanwhile experts are calling for a change in guidelines. Prof Bryan Williams, of the British Hypertension Society, said, “This study is important and the findings could change the way we approach the treatment of high blood pressure.”
Gordon McInnes, Professor of Clinical Pharmacology at the University of Glasgow, said: “The results of this trial are of huge importance to doctors and people treated for high blood pressure. Future treatment will be more effective and, since fewer side effects will lead to better acceptance of therapy, many fewer heart attacks and strokes are likely.”