“That result doesn’t make sense,” he said.
Dr. Tom Marshall, a cardiac disease prevention specialist at the University of Birmingham and a co-author of the study, acknowledged the anomaly, saying, “I wish I had the answer.”
Baseline blood pressures in the population were not high, averaging 130 over 79, he said.
Dr. Frieden said he was also troubled that the trial did not explain whether blood pressure readings were taken by machine or by people with stethoscopes. Some machines and some poorly trained humans get inaccurate results, he said.
The trial was conducted in the “Golestan Cohort,” a group of more than 50,000 Turkmen-speaking people currently enrolled in cancer studies administered by Iranian researchers in coordination with the W.H.O. and the National Cancer Institute.
Dr. Rekha Mankad, director of the Women’s Heart Clinic at the Mayo Clinic in Minnesota, who was not involved in the Iran study, said it had some flaws, including early problems with how clusters were chosen and the fact that each cluster inevitably included some people already on heart-disease medication.
Nonetheless, she said, the overall study was well-designed and she particularly praised the fact that half the participants were women.
“And,” she added, “the adherence rate was fantastic.”
More than 80 percent of the study participants took most of their pills.
Poor adherence, she said, is one of the biggest problems that polypills are meant to fight.
Not only do poor people have little access to doctors or pharmacies, she noted, but “patients constantly say, ‘Listen, doc, I take too many pills,’ and drop something.”
“This is one pill with all the major things patients need,” she added. “Now we need to see how difficult it will be to apply it to the real world.”