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At the heart of general practice since 1960

Study backs GPs on heart attack care

GPs' widespread practice of giving angiotensin receptor blockers to the 30 per cent of heart attack sufferers who cannot tolerate ACE inhibitors ­ in breach of national guidelines ­ has been vindicated by a global study.

Results of the landmark Valiant trial, published in the New England Journal of Medicine, revealed valsartan (Diovan) ­ an angiotension receptor blocker ­ is just as effective in improving survival after a heart attack as a conventional ACE inhibitor.

The benefits of angiotension receptor blockers are already well-known to GPs and cardiologists with significant numbers prescribing them off-licence to the 30 per cent of post-MI patients in the UK who cannot tolerate ACE inhibitors because of serious side-effects.

NICE guidelines on secondary prevention of MI and the NSF for CHD do not include angiotension receptor blockers for secondary prevention of heart attack.

The drugs are 50 per cent more expensive than conventional ACE inhibitors (£15.75 per 28 days compared with £10.46 per 28 days in treatment for hypertension), so there are also fears that

PCTs may refuse to foot

the bill if large numbers of patients are offered the treatment.

Novartis, the manufacturer of valsartan, will apply for a

licence to use the drug in the treatment of post-MI patients early next year.

The Valiant trial, led by Dr Mark Pfeffer of Harvard University Medical School, involved nearly 15,000 patients worldwide, including 53 centres and 840 patients in the UK.

It showed valsartan prolonged survival after a heart attack but also resulted in fewer people stopping treatment due to side-effects compared with an ACE inhibitor.

Dr Nick Summerton, a GP involved in the study and senior lecturer in primary care at the University of Hull, said: 'Angiotension receptor blocker are more expensive and there are going to be arguments around practices and PCTs because they don't fit into quality frameworks.'

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