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"This result does not make sense," he said.
Dr. Tom Marshall, specialist in heart disease prevention at the University of Birmingham and a co-author from the study, acknowledged the anomaly, saying, "I would like to have the answer."
Basic blood pressures in the population were not high, averaging 130 out of 79, he said.
Dr. Frieden also said he was disturbed by the fact that the trial does not explain whether blood pressure readings were taken by machine or by stethoscopes. Some machines and poorly trained humans are getting inaccurate results, he said.
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The trial was conducted in the "Golestan cohort", a group of more than 50,000 Turkophophones speaking 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 Mayo Clinic Women's Cardiology Clinic in Minnesota, who did not participate in the study on Iran, said some weaknesses existed, including early problems with choice of clusters and the fact that each cluster inevitably included people already on medication for heart disease.
Nevertheless, she said, the overall study was well designed and she particularly praised the fact that half of the participants were women.
"And, she added, the membership rate was fantastic."
More than 80% of study participants took most of their medications.
Bad membership, she said, is one of the biggest problems that polypills are supposed to fight.
Not only do the poor have little access to doctors or pharmacies, she noted, but "patients consistently say," Listen, doc, I take too many pills "and drop something."
"It's a pill with everything patients need," she added. "We must now see how difficult it will be to apply it to the real world."
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