Thursday, April 03, 2008


Twofers --pills that include more than one blood-pressure lowering medication-- are a good choice for the treatment of hypertension even when the patient's blood pressure is not that hyper. Not only does the combo form eliminate one prescription co-pay and improve patient compliance, attacking hypertension with two different therapeutic approaches often achieves better control.

A popular and effective twofer pill called Lotrel has now become one of those 'stop the study' pills--therapy so effective that they stopped the study as it was no longer ethical to withhold the drug from the control group. This medication, now available in some strengths as a generic, combines an ACE inhibitor called benazepril (Lotensin) with a calcium channel blocker called amlodipine (Norvasc). Each of these drugs works in a different way to cause relaxation of the blood vessel walls. As a result, the same fluid volume (that would be the circulating blood) moves through a larger space causing a drop in pressure.

Here's what the Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial accomplished. Over 11,000 hypertensive subjects, all of whom were over 55, obese, and many were diabetic were put on one of two different twofer drugs: Lotrel or lotensin plus a diuretic. Those patients who took Lotrel were 20% less likely to end up with a stroke, heart attack, unstable angina, or a need for procedures to open their coronary arteries over the first 3 years of the study. These results were highly significant in this high risk group, and may well change our standard protocols for treating hypertension which has, until now, started with a diuretic then added on an ACE inhibitor.

Per ACCOMPLISH investigator Dr. Michael Weber: Right now, there is a recommendation that when you're putting together combination treatment for hypertension you need to normally include a diuretic as one of the two agents. I'm sure that recommendation will change.

My medical partner and I have long been impressed with the efficacy of Lotrel in hypertension control.


kenju said...

Mr. kenju and I may take that info to his doctor's appointment next week. He takes 3 different BP meds and the combination is not working all that well. The one that did work made him cough, sadly enough.

Thanks for the visit and comments. I think you are right; canes (and crutches, too) are not so easy to learn to coordinate!

Femail doc said...

KJ: Unfortunately, the Lotensin part of Lotrel is one of those 'make you cough' meds. Amlodipine does come teamed up with Diovan, however, which is similar to an ACE inhibitor in its effects but does not produce a cough. This twofer pill is called Exforge.

Mauigirl said...

Very interesting. My husband is on three medications for high BP; I'm on two. While I probably couldn't take the Lotrel (I got the cough from an ACE inhibitor so I'm on Diovan as one of my meds) maybe I could take the Exforge. Husband could probably try the Lotrel as he's not sensitive to ACE inhibitors. I'll have to ask our doctor about this.

james said...

Interesting stuff pal!!
I have been suffering from depression from past 2 months and i am on medications.Can consuming up of Lotrel help me out in any way?

Femail doc said...

James: Lotrel is a great blood pressure medication, but it has no specific actions to improve depression. I hope your other prescriptions will improve your mood!

james said...

Thank you femail doc,
actually due to some personal family problem i initially suffered from hypertention and high blood pressure.This turned into depression.My friend helped me out in curing depression with a very useful resource cure depression
So atleast Lotrel can help in curing hypertension?

Frank said...

In reference to your knees hurting. I have always been in perfect health and very active. I have never in my life had any knee problems or leg problems. I am 51 years old. All of a sudden one day I wake up and can't hardly walk. My knees kill me everyday. I have severe muscle spasms in the back of my legs all the time. I have a hell of a time going up and down steps. I have been to two different knee and leg specialist the are in sports medicine.I have been on them for over a year.