(Agencies)
Updated: 2008-04-01 09:33

Doctors can start with a combination, but few do, partly for lack of evidence, he said.

Guidelines also may change to reflect a second study that found dramatic benefits for treating people in their 80s, an age when blood pressure drugs were not known to be safe or effective.

"The over-80s are the most rapidly expanding segment of our population," and the prevalence of blood pressure rises as people age, Beckett noted.

His study assigned 3,845 older people in Europe, China and several other countries to take the diuretic indapamide or dummy pills plus the ACE inhibitor perindopril as needed to reach a goal of 150/80 from an average starting pressure of 173/91.

The study was stopped last July after monitors saw that those on the diuretic had 39 percent fewer fatal strokes and 21 percent fewer deaths from any cause -- benefits far exceeding what researchers predicted.

Jones called it one of the most important studies at the cardiology meeting and a key advance for older people. The study did not include frail older people in nursing homes, who might reap less benefit than healthier people, doctors noted.

Also at the conference:

-The diabetes drug Actos shrunk artery buildups that can lead to heart disease when tested against glimepiride, an older diabetes drug, in a study of 360 diabetics led by Cleveland Clinic cardiologist Steven Nissen.

"This is the first time in which a diabetes therapy has been shown to slow or prevent" heart disease, he said. Results were published online by the Journal of the American Medical Association.

-A combined analysis of six studies on Celebrex, the only COX-2 inhibitor painkiller still on the market since the withdrawal of Vioxx, gives reassurance of the drug's relative safety for people who do not have big heart disease risk factors when they start taking the drug.

It tested doses used by people with rheumatoid arthritis and other severe chronic pain - roughly double the levels used by people with more common osteoarthritis.

The federally funded study was published in the journal Circulation.

"It gives me some comfort" about the safety of Celebrex, said Nissen, who is leading a larger study of the Pfizer Inc. drug and other painkillers.

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