Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, November 20, 1995                   TAG: 9511200122
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-1   EDITION: METRO 
SOURCE: Associated Press
DATELINE: ANAHEIM, CALIF.                                LENGTH: Medium

DOCTORS DEBATE BENEFITS, IF ANY, OF HEART DRUGS

A spirited debate was held Thursday at an American Heart Association meeting in response to a March report that the drugs, while lowering blood pressure, might increase the risks of heart attack by 60 percent.

The debate drew a standing-room-only crowd of more than 1,000 cardiologists.

The March report triggered a huge disagreement among cardiologists over whether the drugs might actually cause harm. Last week's debate failed to put that question to rest. But, for the first time, it drew striking agreement from some of the nation's leading researchers that there is no evidence the drugs prevent heart disease, strokes or deaths.

Heart association President Dr. Sidney Smith Jr. of the University of North Carolina and four other cardiologists agreed that while the drugs lower blood pressure, evidence of reductions in deaths and disease is lacking.

The drugs in question, called calcium blockers, belong to one of several classes of drugs used to treat hypertension. By affecting the movement of calcium in and out of cells in blood vessels and the heart, the drugs lower blood pressure and, in theory, reduce the risk of heart attack and stroke.

Since the March report, researchers have urged the 6 million Americans taking calcium blockers not to stop their medication without consulting their doctors. But the researchers concede those doctors won't know how to advise their patients.

``What are our patients hearing? They're hearing that cardiologists can't figure out how to treat the most common disease in America,'' fretted Dr. James Muller of Deaconess Hospital in Boston, who worried that the 50 million Americans with hypertension would lose faith in their physicians.

The debaters were Dr. Curt Furberg, a co-author of the March report that first raised the alarm about calcium blockers, and Dr. Franz Messerli of the Oschner Medical Clinic in New Orleans, Furberg's most prominent critic.

The report, co-written by Dr. Bruce Psaty of the University of Washington, found that calcium blockers were associated with a 60 percent increased risk of heart attack overall, and a tripling of risk at the highest doses. Subsequent reports have associated the drugs with a possible increased risk of death.

``We should restrict use of calcium blockers until we have adequate documentation of long-term safety,'' said Furberg, professor of medicine at the Bowman Gray School of Medicine in Winston-Salem, N.C. ``Our position is there are proven alternatives,'' and those alternatives are far less costly.

The alternatives are diuretics, the only class of blood pressure drugs proven to reduce the risks of death and disease,

and beta blockers, which affect the response of the heart and blood vessels to certain nerve impulses, causing blood pressure to drop. Cardiologists disagree whether the effectiveness of beta blockers has been proven.