Cozaar Comes Out on Top in Preventing Stroke and Diabetes

A large head-to-head comparison of two widely used blood pressure pills found one dramatically superior in preventing strokes and diabetes, even though they are equal at reducing hypertension.

The winner was Merck's Cozaar, which was pitted against the older and widely used beta blocker drug known generically as atenolol. The study was paid for by Merck.

Typically, doctors are satisfied simply to get patients' high blood pressure down and feel it does not matter much which kind of drug accomplishes the goal. The new study is the first to show that how blood pressure is lowered can be important, too.

The study found that patients on Cozaar were 25 percent less likely to suffer strokes and 25 percent less likely to develop diabetes. However, the two drugs lowered patients' blood pressure virtually identically.

Dr. Bjorn Dahlof of Goteburg University in Sweden presented the results last month in Atlanta of the American College of Cardiology. The study was also published in last week's issue of the British journal Lancet.

Dahlof said,  "We have known for many years that it matters to lower blood pressure,". "We now know that it matters how we lower blood pressure."

The study involved 9,193 men and women with hypertension in Scandinavia and the United States. All had signs of thickening of the heart's main pumping chamber, an ominous sign of blood pressure damage.

In the United States, about 3.9 million people have these conditions. Putting all of them on Cozaar instead of atenolol would prevent an additional 66,000 strokes and 54,000 new cases of diabetes annually.

Atenolol - or Tenormin - is one of many beta blockers that are widely prescribed after heart attacks. Dahlof said heart attack victims who also have high blood pressure should probably take both medicines.

Cozaar was the first of a newer class of blood pressure medicines known as angiotensin II antagonists.

Smith noted that the ACE inhibitors, another class of hypertension medicine, have also been shown to help prevent diabetes, though not in a head-to-head comparison with a beta blocker.

During almost five years of follow-up, there were 232 strokes among patients on Cozaar, compared with 309 in those taking atenolol. In addition, 241 of the Cozaar patients developed diabetes, as did 319 on atenolol.

Cozaar appeared to be especially effective in those who already had diabetes. Their risk was of dying from cardiovascular disease was 37 percent lower than the atenolol patients'.

Cozzar has properties that go beyond blood pressure lowering, although just what these are is not entirely known.

Dahlof estimated that one-third of the additional benefit comes from Cozaar's better reduction of heart wall thickening, while another third might be due to lowering of uric acid.

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