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Pfizer Inc.'s Norvasc, in combination with another drug, helped lower patients' risk of heart attack, stroke and death, giving doctors another first-line option to treat high blood pressure, a study found.

Those who took Norvasc, available as a generic, with the blood-pressure medicine benazepril had about a 20 percent lower risk of heart attack, stroke or dying than those taking a combination of benazepril and a diuretic, research in this week's New England Journal of Medicine found. Patients' blood pressures were about the same in each group.

About 73 million U.S. adults and about 1 billion adults worldwide have high blood pressure, or hypertension, according to an accompanying editorial in the Journal. Based on these findings, Norvasc combined with medicines such as benazepril should be among the initial treatments given to help patients lower their blood pressure, study author Michael Weber said.

"Many clinicians will become aware of these findings and will start to switch their patients," Weber, a professor of medicine at the State University of New York's Downstate Medical Center in Brooklyn, said Wednesday in a telephone interview.

Norvasc is a calcium-channel blocker, while benazepril is in the class of drugs known as angiotensin-converting enzyme, or ACE, inhibitors. A single-pill combination of the medicines is sold by Novartis AG as Lotrel and is available as a generic.

Diuretics drain the body of excess fluid that may increase blood pressure, while calcium-channel blockers lower pressure by relaxing blood vessels and preventing calcium from entering the cells. An ACE inhibitor prevents the body from producing angiotensin, which can narrow blood vessels.

Researchers looked at 11,506 patients who were recruited from October 2003 to May 2005 and followed, on average, for about 36 months.

Patients received treatment with benazepril and Norvasc, known generically as amlodipine, or hydrochlorothiazide, a diuretic. Those on the combination treatment with Norvasc were about 20 percent less likely to have a fatal or non-fatal heart attack than those taking the combination including the diuretic, Weber said. That group also was about 20 percent less likely to need interventions such as heart-bypass surgery or stents, he said.

The study ended several months early because of the beneficial findings.

U.S. guidelines currently suggest doctors begin treating high blood pressure with a single pill, usually a diuretic. Then other medicines are added until patients' blood pressures are lowered.

This study "sort of changes the paradigm of what we've been told that diuretics should be the first line," said Suzanne Steinbaum, a cardiologist at Lenox Hill Hospital in New York, who wasn't an author of the paper.