October 19, 2009
Two medications commonly used to treat high blood pressure appear to be
effective in treating a common type of heart disease known as stable ischemic
heart disease, according to a new comparative effectiveness review funded by the
Department of Health & Human Services' (HHS) Agency for Healthcare Research
and Quality (AHRQ). A version of the analysis was posted in the October 20
online version of the
Annals of Internal Medicine.
Treatment featuring the two medications—inhibitors of angiotensin-converting
enzyme, or ACE inhibitors, and angiotensin receptor blockers, or ARBs—can lead
to a reduction in death, risk of heart attack, risk of stroke and fewer
hospitalizations for heart failure for patients suffering from stable ischemic
heart disease, researchers found. However, the drugs have risks of their own.
Risks associated with ACE inhibitors include a persistent cough, sudden
fainting, too much potassium in the blood, and dangerously low blood pressure
(hypotension). Risks associated with ARBs include too much potassium in the
blood and low blood pressure.
"Stable ischemic heart disease is a major cause of death in the United
States, so these findings are very encouraging," said AHRQ Director Carolyn M.
Clancy, M.D. "This comparative effectiveness report will be a useful tool for
patients to help them work with their clinicians to make choices on treatment."
Stable ischemic heart disease occurs when the flow of oxygen-rich blood to
the heart is reduced because of narrowed or blocked arteries. Symptoms of stable
ischemic heart disease include decreased tolerance of exercise and severe chest
pain on exertion (known as angina), which afflicts about 9 million U.S. adults.
Long-term risks of stable ischemic heart disease include heart failure and heart
attack. Overall, heart disease is among the Nation's most common and deadly
illnesses, afflicting nearly 80 million Americans and killing nearly 2,400 every
day.
Standard treatment of stable ischemic heart disease consists of a
modification of diet, exercise and medications including aspirin,
anti-cholesterol drugs, nitroglycerin and beta blockers. These can keep the
disease from worsening. However, while standard treatment usually alleviates
chest pain, it is not universally successful in reducing risk of heart failure
or heart attack.
For patients with advanced stable ischemic heart disease, treatment can
include heart surgery (coronary artery bypass graft, in which surgeons use a
blood vessel harvested from the chest, leg or arm to reroute blood flow around
narrowed heart arteries) or angioplasty (a procedure in which a catheter is used
to inflate a balloon inside the plaque-narrowed artery and a mesh tube called a
stent is usually inserted to keep the artery open).
ACE inhibitors and ARBs, which are commonly prescribed to combat high blood
pressure, also are used for treatment of a heart attack and chronic heart
failure. Captopril (sold as Capoten), the first ACE inhibitor to be taken
orally, has been commonly available in the United States since the early 1980s.
ARBs, first approved for use in the United States in the mid-1990s, often are
prescribed when a patient has adverse effects to ACE inhibitors, but ACE
inhibitors are used more commonly.
The AHRQ report found that patients with stable ischemic heart disease who
take an ACE inhibitor in addition to standard treatment can reduce the
likelihood of several negative outcomes, including death from heart attack or
heart failure, non-fatal heart attacks, hospitalization for heart failure, and
revascularization (surgeries that reroute blood to the heart). Patients who take
an ARB in addition to standard medications can reduce their risk of death from a
heart-related cause, heart attack or stroke.
While some patients and clinicians pursue a course of treatment using both
ACE inhibitors and ARBs, the report found that combined treatment does not show
any benefit over an ACE inhibitor alone and that risks include fainting,
diarrhea, low blood pressure and kidney problems.
The report found that existing studies provide few data on the medications'
benefits or harms in specific populations such as people of different genders,
ethnicity, diabetic status or those who have or don't have high blood
pressure.
AHRQ's new report,
Comparative
Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II
Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic
Heart Disease, is the newest research review from the Agency's
Effective Health Care Program. That program, authorized by the Medicare
Prescription Drug, Improvement and Modernization Act, represents an important
federal effort to compare alternative treatments for health conditions and make
the findings public. The program is intended to help patients, doctors, nurses,
pharmacists and others choose the most effective treatments. The new report's
findings will soon be available in plain-language summary guides for patients,
clinicians and policymakers. Summary guides on numerous clinical topics, as well
as other information and background on the Effective Health Care Program, can be
found at http://www.effectivehealthcare.ahrq.gov.
For more information, please contact AHRQ Public Affairs: (301) 427-1258
or (301) 427-1998.
Use Twitter to get AHRQ news updates: http://www.twitter.com/ahrqnews/
Internet Citation:
High Blood Pressure Medicines Show Promise for Treating Heart
Disease. Press Release, October 19, 2009. Agency for Healthcare Research
and Quality, Rockville, MD.
http://www.ahrq.gov/news/press/pr2009/hbpmedpr.htm
