NICE to review guidance on hypertension treatments
pharmafile | September 22, 2005 | News story | Research and Development |Â Â Â
NICE has set up a specialist advisory group to review new data which could lead to thousands of heart patients in the UK having their treatment regimes altered.
The Institute will evaluate its current guidance on hypertension treatment in the wake of new data which suggests a combination of an ACE-inhibitor, calcium channel blocker and statin could save thousands of lives.
NICE issued new hypertension guidance only last year but the significance of the new data has prompted it to launch a new review.
The Institute said it would review all the new data to decide if new guidance was required and, if so, would publish its updated recommendations within six months.
Current guidelines recommend therapy should normally begin with a low dose thiazide-type diuretic. If necessary at second line a beta-blocker should be added, unless the patient is at raised risk of new onset diabetes, in which case an ACE-inhibitor should be added instead. At third line, a calcium-channel blocker should be added.
But trial data from the Pfizer sponsored Anglo Scandinavian Cardiac Outcome Trial (ASCOT) the largest-ever European study of high blood pressure treatment has brought this regime into question.
Professor Peter Littlejohns, NICE clinical and public health director, said: "NICE feels it is appropriate to look at this data in the context of our existing recommendations to see whether any revisions might be necessary."
The five-year study involved more than 19,000 men and women with high blood pressure who were at a moderate risk of strokes and heart attacks.
Results showed that Servier's ACE inhibitor Coversyl (perindopril) combined with Pfizer's calcium channel blocker Istin (amlodipine) significantly outperformed the traditional combination of a beta-blocker and a diuretic.
Data suggests the new combination of blood-pressure-lowering drugs cut the risk of strokes by about 25%, heart attacks by 15%, cardiovascular deaths by 25% and new cases of diabetes by 30% compared with the standard treatment.
In a further arm of the trial, the addition of a cholesterol-lowering drug, Pfizer's Lipitor (atorvastatin), to the new combination further reduced the risk of strokes and coronaries – irrespective of the patient's original cholesterol level, researchers said.
Both trials were terminated early as a result of the reduction in heart attacks and strokes experienced by those patients who received the new combination therapy.
Co-chairman of the ASCOT steering committee, Professor Peter Server, said: "The combination of the contemporary blood pressure lowering drugs, amlodipine and perindopril, plus effective lowering of cholesterol abolished more than half the risk of strokes and heart attacks – the most important causes of death in millions of men and women with high blood pressure."
In light of the results, trial investigators said that health systems would have to evaluate their guidance on managing hypertension.
However, they warned against patients discontinuing their treatment of the standard drug combination of a beta-blocker and diuretic for hypertension.
"This is an effective and proven combination for lowering blood pressure and its associated risks," commented Professor Server.
"What ASCOT has shown is that for many patients the combination of newer drugs may be even a better option."
Beta-blockers and diuretics are among the most commonly prescribed treatments for hypertension sufferers in the UK.
Proponents of the data said the new combination would save the NHS money, given the reduction in emergency medical care associated with heart attacks, strokes and diabetes it seems to offer. But health economists are still evaluating the financial benefits of the newer, more expensive drugs for treating hypertension.
There are nearly eight million people in the UK who currently receive treatment for hypertension.
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