Current approach to high blood pressure 'not most effective'

<em>Picture: Bernard Goldbach</em>
Picture: Bernard Goldbach
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.”

  • Antoine Bisset

    It takes a long time for the medical profession to see the obvious when it does not accord with previously accepted practice.
    There are few problem areas where the best answer is not to go in hard and fast with weight.
    The use of antibiotics is another medical example. Doctors invariably start by prescribing some weak and ineffective antibiotic and then move to more powerful only when the first is seen not to work. By which time the infection has progressed and the patient is exhausted. This also needs to change.

  • Jaimeson

    A more important matter vis a vis hypertension is how it is diagnosed. Using my own experience, it is wrong to diagnose a person as hypertensive on the basis of a couple of random BP measurements at the GP’s surgery. Personally like many people I am a victim of ‘white coat syndrome’ and indeed of ‘first measurement syndrome’ too when I take my own BP readings on my own machine. For those who don’t know, this is the syndrome where the BP is well elevated due to fear about what the result will show.
    On three occasions when I was randomly diagnosed as hypertensive, I asked for 24 hour tests to be done which showed my BP was normal each time. Thus not only did I save myself from being medicated unnecessarily but more to the point I prevented a waste of resources by the NHS.

  • Economix

    What this article fails to address are lifestyle changes that may make a difference to a patient’s blood pressure. In our hypertension clinic we have had success with many patients by only adapting their diet, exercise, smoking, and alcohol intake. Drugs should not be seen as the first step in all patients (whether it’s one or two drugs!). Patients need to get the message that drugs are not a panacea – there are limited agents available and not everyone tolerates them – they are a last resort and should be employed when a trial of lifestyle changes have failed or a patients blood pressure is dangerously high.