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By Lee Hui Chieh
PEOPLE at high risk of a heart attack or a stroke and who cannot take the standard protective medication now have an alternative drug.
A study of close to 6,000 such patients from 40 countries, including Singapore, has shown that the drug, called telmisartan, cut their risk of suffering and dying from a heart attack or stroke by 13 per cent over five years.
People at high risk of a heart attack or stroke are those who have already had either one of these, as well as those who have had heart bypasses or other procedures to unclog their arteries, and those who have organ damage from diabetes.
Such individuals are usually given drugs from the class called angiotensin-converting enzyme (ACE) inhibitors.
But about a third of patients here have to stop taking this type of medication because it brings on a bad cough.
The study has shown that telmisartan can be used as a substitute drug for such patients because it offers similar protection but fewer side effects.
In the study, on top of any existing medication they were on, half the patients took one pill of telmisartan a day, while the other half took a placebo.
Two in 10 patients had to stop taking it because their blood pressure became too low, or they fainted or had diarrhoea. About the same number had to stop taking the placebo.
Telmisartan has traditionally been used only to lower high blood pressure.
Based on the results of the study, doctors should now consider prescribing it to high-risk patients who cannot take ACE inhibitors - even if they do not have high blood pressure, said Dr Bernard Kwok, 42, a senior consultant from the National Heart Centre who conducted the study on patients here.
The downside to telmisartan, however, is that it is more expensive than ACE inhibitors. A month's supply costs $40 to $50, against $9 for cheaper brands of ACE inhibitors.
This is why telmisartan will not replace ACE inhibitors for all types of patients, Dr Kwok said.
Investment manager C.S. Teo, 44, switched from taking an ACE inhibitor to telmisartan three months ago, even though he does not have high blood pressure and has to pay $6 more a month.
He had been troubled by a dry cough that came and went during the more than a year he had been on an ACE inhibitor.
He said: 'Telmisartan doesn't cost much more, and there's no cough now.'
Dr Kwok presented the study results here yesterday at a press conference called by telmisartan's manufacturer, Boehringer Ingelheim.
This article was first published in The Straits Times on September 12, 2008.
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