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Senior Citizen Health & Medicine
Combo Drug Caduet Better for High Blood Pressure
than Lipitor and Norvasc
One-pill program also much less expensive say
researchers at American Heart Association Forum
 May
11, 2007 Well over half of all senior citizens suffer with high blood
pressure and the additional risk factors for heart disease. They may
benefit more from taking one tablet rather than two, if their current
treatment combines the lipid-lowering medication atorvastatin (Lipitor)
with the blood pressure-lowering medication amlodipine (Norvasc),
researchers reported today at the American Heart Association's 8th
Scientific Forum on Quality of Care and Outcomes Research in
Cardiovascular Disease and Stroke.
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Read the latest news on Senior
Health & Medicine |
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In an analysis, researchers found that a
single-tablet combination of the two medications is less costly than a
two-tablet combination and is at least as effective, if not more so, in
preventing cardiovascular events. Patients take the single-tablet
medication or the two-tablet medication daily.
A single tablet combination of amlodipine/atorvastatin
is available as Caduet.
"This is a novel research approach that examines
the economic and clinical implications of high blood pressure and
cholesterol in the real world," said Timothy W. Smith, lead author of
the study and senior director of Informatics for ValueMedics Research (a
unit of IMS Health Inc), a health outcomes research and consulting firm
in Falls Church, Va.
Researchers used a treatment approach and a
population similar to the Anglo-Scandinavian Cardiac Outcomes Trial
Lipid-Lowering Arm (ASCOT-LLA), which demonstrated the benefits of
adding atorvastatin to high blood pressure treatment in adults with
three or more risk factors for heart disease, including abnormal ratio
of total-to-high density lipoprotein (HDL the "good" cholesterol),
previous stroke, male gender, 55 years or older and smoking.
In ASCOT-LLA, researchers examined 10,305 patients
with high blood pressure and additional risk factors for heart disease
with lowto-moderate cholesterol levels and found the addition of
atorvastatin to high blood pressure treatment resulted in a significant
reduction in unfavorable outcomes: fatal and non-fatal heart attack,
stroke and chest pain.
Nearly one in three U.S. adults has high blood
pressure. About one-third of them do not know they have it. Uncontrolled
high blood pressure can lead to stroke, heart attack, heart failure or
kidney failure.
High blood pressure is defined as systolic pressure
of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher.
Systolic pressure is the force of blood in the arteries when the heart
contracts to pump blood to the body. Diastolic pressure is the force in
the arteries when the heart relaxes between beats. Normal blood pressure
is less than 120 mm Hg systolic pressure and less than 80 mm Hg
diastolic pressure. (Read more about high blood
pressure below news story.)
The results of the study showed that when
hypothetical cohorts of 100,000 people fully adhered to the one-tablet
and two-tablet regimens, each treatment group had 3,520 cardiovascular
events over four years, such as fatal and non-fatal heart attack, chest
pain and stroke.
Medical costs over four years were $7,665 for the
two-tablet regimen and $6,471 for the one-tablet regimen.
A further analysis, examining the impact of lower
compliance more typical in real-world populations, showed that four-year
cardiovascular events increased for the two-tablet regimen to 6,990
versus 6,859 for the one-tablet regimen.
Researchers concluded the one-tablet regimen was
less costly and at least as effective as the two-tablet regimen.
Sensitivity analyses confirmed these results when varying the
effectiveness associated with partial adherence from 0 percent to 100
percent of the effectiveness of full adherence.
Researchers in the ValueMedics study used U.S.
databases to estimate direct medical costs and adverse treatment
outcomes over four years among adults with similar characteristics to
those examined in ASCOT-LLA. Amlodipine (brand name Norvasc) is in a
class of medications called calcium channel blockers. It lowers blood
pressure by relaxing the blood vessels so the heart does not have to
pump as hard.
Atorvastatin (brand name Lipitor) is in a class of
medications known as statins or HMG-CoA reductase inhibitors. It lowers
the level of cholesterol in the blood.
(Read more about high blood
pressure below news story.)
Editors Notes:
Co-authors are Spencer B. Cherry; Joshua S.
Benner, Sc.D. and Simon S. Tang, M.P.H.
Funding for this study was provided by Pfizer
Inc.
The American Heart Association notes that
statements and conclusions of abstract authors that are presented at
American Heart Association/American Stroke Association scientific
meetings are solely those of the abstract authors and do not necessarily
reflect association policy or position. The associations make no
representation or warranty as to their accuracy or reliability.
About High Blood Pressure from National Heart, Lung
and Blood Institute
Who Is At Risk for High Blood Pressure?
About 65 million American adultsnearly 1 in 3have
high blood pressure.
In the United States, high blood pressure occurs
more often in African Americans than in Caucasians. Compared to other
groups, African Americans:
● Tend to get high blood pressure earlier in life
● Usually have more severe high blood pressure
● Have a higher death rate from stroke, heart
disease, and kidney failure
Many people get high blood pressure as they get
older. Over half of all Americans aged 60 and older have high blood
pressure. This is not a part of healthy aging! There are things you can
do to help keep your blood pressure normal, such as eating a healthy
diet, maintaining a healthy weight, and getting enough physical
activity.
Your chances of developing high blood pressure are
also higher if you:
● Are overweight
● Are a man over the age of 45
● Are a woman over the age of 55
● Have a family history of high blood pressure
● Have prehypertension (that is, blood pressure
in the 120139/8089 mmHg range)
Other things that can raise blood pressure include:
● Eating too much salt
● Drinking too much alcohol
● Not getting enough potassium in your diet
● Not doing enough physical activity
● Taking certain medicines
● Having long-lasting stress
● Smoking (smoking can cause a temporary rise in
blood pressure)
What Is High Blood Pressure?
High blood pressure is a blood pressure reading of
140/90 mmHg or higher. Both numbers are important.
Nearly 1 in 3 American adults has high blood
pressure. Once high blood pressure develops, it usually lasts a
lifetime. The good news is that it can be treated and controlled.
High blood pressure is called the silent killer
because it usually has no symptoms. Some people may not find out they
have it until they have trouble with their heart, brain, or kidneys.
When high blood pressure is not found and treated, it can cause:
● The heart to get larger, which may lead to
heart failure.
● Small bulges (aneurysms (AN-u-risms)) to form
in blood vessels. Common locations are the main artery from the heart
(aorta); arteries in the brain, legs, and intestines; and the artery
leading to the spleen.
● Blood vessels in the kidney to narrow, which
may cause kidney failure.
● Arteries throughout the body to "harden"
faster, especially those in the heart, brain, kidneys, and legs. This
can cause a heart attack, stroke, kidney failure, or amputation of part
of the leg.
● Blood vessels in the eyes to burst or bleed,
which may cause vision changes and can result in blindness.
What Is Blood Pressure?
Blood is carried from the heart to all parts of
your body in vessels called arteries. Blood pressure is the force of the
blood pushing against the walls of the arteries. Each time the heart
beats (about 6070 times a minute at rest), it pumps out blood into the
arteries. Your blood pressure is at its highest when the heart beats,
pumping the blood. This is called systolic (sis-TOL-ik) pressure. When
the heart is at rest, between beats, your blood pressure falls. This is
the diastolic (di-a-STOL-ik) pressure.
Blood pressure is always given as these two
numbers, the systolic and diastolic pressures. Both are important.
Usually they are written one above or before the other, such as 120/80
mmHg (measured in millimeters of mercury, a unit for measuring
pressure). When the two measurements are written down, the systolic
pressure is the first or top number, and the diastolic pressure is the
second or bottom number (for example, 120/80). If your blood pressure is
120/80, you say that it is "120 over 80."
Blood pressure changes during the day. It is lowest
as you sleep and rises when you get up. It also can rise when you are
excited, nervous, or active.
Still, for most of your waking hours, your blood
pressure stays pretty much the same when you are sitting or standing
still. That level should be lower than 120/80 mmHg. When the level stays
high, 140/90 mmHg or higher, you have high blood pressure. With high
blood pressure, the heart works harder, your arteries take a beating,
and your chances of a stroke, heart attack, and kidney problems are
greater.
What Is Normal Blood Pressure?
A blood pressure reading below 120/80 mmHg is
considered normal. In general, lower is better. However, very low blood
pressure can sometimes be a cause for concern and should be checked out
by a doctor.
More information at
http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html
Additional information about treatments for
hypertension can be found at
www.fda.gov/fdac/features/1999/499_hbp.html.
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