Angioplasty, an extremely common surgery for opening clogged arteries, usually requires a two- to three-day hospital stay. But an 11-year-old anti-clotting drug could turn the procedure into day surgery. A Quebec study of 1,005 patients, presented at an American Heart Assn. meeting on Sunday, found that those who were given a dose of ReoPro, an 11-year-old drug from Johnson & Johnson (JNJ), and then sent home just four to six hours after their angioplasty procedure did as well after 30 days as those who were given the drug intravenously over 12 hours and hospitalized overnight.
At the same meeting, another study found that the inflated arm cuff commonly used to diagnose high blood pressure may not be good enough, because it doesn't determine blood pressure around the heart, where the real danger lies. To determine pressure in the main arteries adjacent to the heart, researchers used a computerized device called SphygmoCor, made by Atcor Medical Holdings in Sydney, Australia. Researchers using the device discovered that different hypertension drugs can have a dramatically different affect on blood pressure around the heart, despite a similar impact on pressure in the arm.
NEW TECHNIQUE. Both of these studies, presented at the AHA's annual Scientific Sessions in Dallas, focused on better ways to use existing drugs, a common theme at this year's meeting, where few new drugs are making a splash. However, given that heart disease is the leading cause of death in most of the developed world -- and that heart drugs are among the biggest sellers -- any study that points the way to better ways of using them can have a significant impact on both patients and health-care costs.
The Quebec study, led by Dr. Olivier Bertrand of Laval University in Quebec City, was an update of an early study done several years ago, before the use of stents to hold the arteries open became commonplace. In the earlier trial, the 12-hour drip of ReoPro proved to be superior to a single dose. In the newer study, the doctors also used an artery in the wrist to get the stent to the blockage, rather than the usual large leg artery. This arm method is only just beginning to gain acceptance, Bertrand says, and studies have found it associated with fewer complications and increased patient satisfaction. He says the single-dose study should now be repeated in multiple hospitals.
The blood-pressure study did more than raise questions about the usefulness of the arm cuff method of measuring hypertension. It also demonstrated that Pfizer's (PFE) Norvasc, a calcium-channel blocker, was more effective at reducing blood pressure around the heart than older and widely prescribed drugs known as beta blockers.
WRONG ASSUMPTION. Norvasc is due to come off patent next year, so Pfizer likely won't get much benefit from the news, but Dr. Bryan Williams of the University of Leicester in Britain, lead investigator of the study, says the study could have a big impact on patients: "The results of this study are clear-cut, dramatic, and potentially very important. It also may explain why certain types of hypertension treatment might be more effective than others."
Williams' study covered 2,199 people in Europe, part of a larger 20,000-person study of hypertension medicines that was ended early when it became clear that patients receiving Norvasc did better than those on beta blockers -- including a 14% reduction of death from heart disease.
The researchers found that, although arm blood pressure differed little between treatment groups, those taking Norvasc had substantial reductions in pressure around the heart. Says Williams: "The assumption has been that all types of blood pressure treatments are equally effective. We show that this assumption is untrue." The AHA meeting will continue through Wednesday.
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Arnst, who's attending the AHA conference, is a senior writer for BusinessWeek in New York
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