Two medicines are better than one in hypertension

By Mark Watson

Results from the British Hypertension Society’s (BHS) study Pathway-1 reveals that treating early stage hypertension with two medicines at the same time rather than one can significantly reduce blood pressure and may cut the subsequent risk of strokes and heart attacks.

The study allocated both hydrochlorothiazide and losartanto to 304 patients who had untreated high blood pressure and only one of the medicines to a further 301 patients. Those who received two medicines had a much lower blood pressure over the first four months of the study.

This was true even when the best single medicine at optimal dose was chosen using the best predictors of effectiveness. After the first four months both groups received two medicines for a further four months with no significant downside to patients receiving both medicines.

BHS President Professor Tom MacDonald said: “An understandable concern was that two medicines might have unacceptably more side effects such as dizziness compared with single medicine therapy but we did not find this. As such, we are reassured that we can now recommend combined medicines for the initial treatment of patients with high blood pressure which will reduce blood pressure and result in fewer strokes, heart attacks and sudden deaths.”

Professor MacDonald staff member at the University of Dundee, is part of the BHS’s Research Network of academic researchers, with Professor Bryan Williams from University College London. The team was led by Professor Morris Brown from the University of Cambridge.

Professor Williams, said: “This study should change guidelines to recommend starting treatment with two medicines as standard therapy for high blood pressure for the vast majority of people.”