Aggressive Approach May Help More Heart Patients

Aggressive treatment of hypertension in heart disease patients can reduce the risks of heart attacks, stroke and hospitalization by as much as 30% -- even in patients whose blood pressure is close to normal, researchers reported today.

Such aggressive treatment can even halt the buildup of artery-blocking plaque, Cleveland Clinic Foundation researchers reported in the Journal of the American Medical Assn.

Patients with blood pressures in what is called the “high normal” range -- from 120/80 to 140/90 -- would typically not be considered candidates for blood pressure-lowering treatment. But the new study showed that treating them with a calcium channel blocker called amlodipine provided substantial benefits, even though the drugs produced only a modest drop in pressure.

In some ways, the new study is analogous to recent studies that have found that aggressive treatment of heart disease patients with cholesterol-lowering drugs can reduce adverse outcomes even if their cholesterol levels are normal to begin with.

The studies hint that blood pressure and cholesterol levels that are considered “normal” in healthy people may be too high in those with damaged cardiovascular systems.

The new findings suggest that people with heart disease represent a “special population” with different target levels for blood pressure and cholesterol, said Dr. Carl J. Pepine of the University of Florida College of Medicine.

Dr. Steven E. Nissen and his colleagues at the Cleveland Clinic studied 1,991 patients with coronary artery disease who were already receiving conventional treatment, including cholesterol-lowering agents, aspirin and heart drugs. Their average blood pressure was 129/78, considered high normal. Previous studies in such patients have enrolled only those with blood pressures higher than 140/80.

A third of the patients received amlodipine, sold under the brand-name Norvasc, in addition to their conventional treatment; a third received a different antihypertensive drug (an angiotensin-converting enzyme inhibitor called enalapril); and a third received a placebo.

Over the two years of the study, those receiving amlodipine were 30% less likely to suffer an adverse event, such as a heart attack, stroke, bypass surgery or death. Those receiving enalapril were 15% less likely to suffer the events.

Examination of coronary arteries in a subgroup of the patients showed no further buildup of plaque in those receiving amlodipine, a small increase in those receiving enalapril, and a large increase in those getting the placebo.

Experts said that the study was not big enough to justify a change in prescribing guidelines, but that more research was called for.