13 January 2011
Breakthrough – or old news?
“Breakthrough for blood pressure patients” screamed the headline in the newspapers on 13th January in response to this article in the online edition of The Lancet. But was it? The fuss was about research which showed that the selective renin inhibitor, aliskiren, taken as dual therapy in combination with the calcium channel blocker, amlodipine, was more effective at reducing blood pressure than a single drug.
Could one say, “tell us news not history” ?
Ever since it came out, it has been recommended that aliskiren is better used in combination with other drugs. It has also been known for years that combination therapy for hypertension is almost always necessary, using two, three or even four drugs.
The only thing that could possibly be said to be new is the recommendation that dual therapy should be used right from the start.
This single research project in no way nullifies the advice given as a result of the iconoclastic ASCOT Trial which was a classic head-to-head trial and came down firmly in favour of the combination of a calcium channel blocker and an ACE inhibitor as opposed to a beta blocker and a thiazide diuretic using proper outcome measures rather than surrogate endpoints as this new trial does. Even when the ASCOT trial was planned, it was accepted by the investigators that mono-therapy had no significant place in the management of hypertension.
Professionals at the coal face have been advocating combination drugs as a method of improving compliance as well as outcomes.
Yes, one could say, “tell us news not history”.
Much more interesting is the continuing discussion about the concept of the poly pill.