New Hope for High Blood Pressure Treatment

Physicians now say that in order to effectively control high blood pressure, patients will usually require more than one medication. However, despite calls by the federal government and numerous medical associations for the increased use of this effective treatment strategy - combination therapy - this advice is often ignored or overlooked.

This study shows that Lotrel - two potent high blood pressure medications in one capsule - effectively lowered blood pressure and reduced swelling of the feet and legs in patients switched from Norvasc, a single medication.

Also, having two medications in one capsule reduces patients' pill counts, a serious issue for seniors taking multiple medications for numerous conditions each day.

General Infromation

It is estimated that more than 50 million Americans have high blood pressure. However, less than 50 percent of treated patients are controlled and about one-third are unaware they have the condition. African-Americans and Hispanics are especially at risk.

Untreated and undertreated high blood pressure can have a severe impact on the heart and blood vessels. For example, a heart under the stress of high blood pressure can enlarge. Arteries may also stiffen making it more difficult for the heart to pump blood through them. These disorders and other complications can lead to heart attacks, stroke and kidney disease.

June 10, 2002 – Patients experienced significantly better blood pressure control and less swelling of the feet and legs when switched from a widely-prescribed hypertension medication (amlodipine) to a single-capsule combination of two blood pressure-lowering drugs (amlodipine/benazepril), according to a study published in the June edition of the American Journal of Hypertension and led by an Ochsner researcher.

The study, LOtrel: Gauging Improved Control (LOGIC), is one of the first large trials conducted in a community based setting that implements recommendations from the federal government and health organizations for multiple-drug therapy in patients whose blood pressures are uncontrolled on a single medication.

“High blood pressure is about more than just lowering the numbers. It is a complex disease requiring intensive and innovative treatment. However, physicians often do not treat hypertension aggressively enough – partly because of medication side effects,” said Dr. Franz H. Messerli, Medical Director, Division of Research at the Ochsner Clinic Foundation in New Orleans, LA and principal investigator of the study. “LOGIC demonstrates that combination therapy – providing two drugs in one capsule – may offer a possible solution to this problem: potent blood pressure lowering with reduced incidence of a common side effect.”

LOGIC involved 9,208 patients who were evaluated in more than 1,500 doctors’ offices across the United States. LOGIC evaluated the blood pressure lowering ability and side effect profile of a low-dose combination of amlodipine and benazepril (marketed under the brand name Lotrel®) in patients with mild to moderate hypertension who were formerly taking only amlodipine (marketed under the brand name Norvasc®). LOGIC was unique in that it was specifically designed to determine how physicians could use amlodipine/benazepril to manage high blood pressure in patients seen in everyday practice, rather than in those receiving care in controlled settings like medical research centers.

In the study, physicians switched 7,468 patients who failed to reach a diastolic blood pressure goal of less than 90 mmHg with 5 mg or 10 mg of amlodipine to 5/10 mg or 5/20 mg of amlodipine/benazepril. Researchers also switched a second group of 1,739 patients who experienced pedal edema while treated with amlodipine to amlodipine/benazepril.

After four weeks of treatment, the first group of patients experienced significant reductions in their average systolic and diastolic blood pressure (15.6/11.5 mmHg) when they were switched to the amlodipine/benazepril combination (p <0.001). Amlodipine-associated pedal edema improved in 85 percent of the second group of patients. Pedal edema completely resolved in 42 percent of these patients (p<0.001). The most common side effects seen in the amlodipine/benazepril combination were cough, dizziness and headache.

The concept of using multi-drug therapy in patients with high blood pressure represents a significant shift from standard hypertension management strategies. In fact, recent research indicates that many patients require an average of three different medications to reach recommended blood pressure goals.

“Hypertension is a major contributor to heart attacks, kidney disease and stroke in the United States,” noted Dr. Messerli. “It has become clear that, for many patients, single-drug therapy is not enough to reach their blood pressure goals. LOGIC demonstrates that combination therapy may be an important therapeutic option for these patients.”

The study was sponsored by Novartis Pharmaceuticals.

For more information about LOGIC or to learn more about high blood pressure, please contact the Ochsner Clinic at 1-800-874-8984 (within Louisiana) or 1-800-348-7876 (outside of Louisiana) or log on to www.ochsner.org

Ochsner Clinic Foundation is a not-for-profit, fully integrated health care delivery system, with a 441-bed acute care hospital, employing over 500 physicians in nearly 70 medical specialties. Ochsner offers services in over 25 clinics located throughout Southeast Louisiana and Latin America.