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Update in Cardiology
- Elliot Rapaport, MD
- From San Francisco General Hospital and University of California, San Francisco, San Francisco, California.
2006 Series: Update Sessions from ACP's 2006 Annual Session
This Update in Cardiology features 13 articles published in 2005. They were chosen from among thousands because of their particular interest or importance to the field, focusing on hypertension, diabetes and cardiovascular disease, acute myocardial infarction, and heart failure. Changes to clinical practice emerging from these articles are shown in the Table .
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Hypertension
Amlodipine Prevented More Major Cardiovascular Events and Induced Less Diabetes than Atenolol
Although the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (1) recognizes that most patients with hypertension will require 2 or more antihypertensive agents to achieve normal blood pressure, few data are available on how to choose which combination of antihypertensive agents to use. Dahlöf and colleagues compared the effect of amlodipine and perindopril with that of atenolol and bendroflumethiazide on nonfatal myocardial infarction (MI) and fatal coronary heart disease (CHD). They chose these combinations because β-blockers and diuretics were the most commonly used drugs when the trial started and few high-quality trials demonstrated the safety and efficacy of dihydropyridine calcium-channel blockers or angiotensin-converting enzyme (ACE) inhibitors in high-risk patients with hypertension.
The investigators randomly assigned 19 257 hypertensive patients between 40 and 79 years of age who had at least 3 other cardiovascular risk factors to initially receive 5 mg to 10 mg of amlodipine with 4 mg to 8 mg of perindopril added as required (n = 9639) or 50 mg to 100 mg of atenolol with 1.25 mg to 2.5 mg of bendroflumethiazide and potassium added as required (n = 9618). The primary end point was the cumulative incidence of nonfatal MI (including silent MI) and fatal CHD.
The study was stopped early after a median of 5.5 years because the amlodipine group had a 23% lower likelihood of fatal or nonfatal stroke (327 patients vs. 422 …
