Blood
pressure and cholesterol lowering drugs improve survival in patients with
hypertension even after more than a decade, suggest results from the ASCOT
Legacy study presented at ESC Congress 20181 and published simultaneously
in The Lancet.
The
ASCOT Legacy study is the long-term follow-up of more than 8000 hypertensive
patients from the UK, almost 16 years after they had had been recruited in the
multicenter Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), between 1998 and
2000. The study participants also had three or more additional risk factors for
cardiovascular disease.
In the
BP lowering arm, patients who were treated with calcium channel blocker based
treatment regimen (amlodipine) + perindopril, if needed for 5.5 years reduced
their chances of stroke-related death over ten years by 29% in comparison to
those taking an older regimen, based on atenolol (a beta-blocker) +
bendroflumethiazide (a diuretic) and potassium, if needed. There was a
non-significant trend towards 10% fewer cardiovascular deaths with the newer
therapy.
In the
lipid lowering arm, patients with average (6.5 mmol/l) or below average blood
cholesterol levels at the start of the trial who took a statin (atorvastatin) for
3.3–5.5 years had a 15% reduction in rates of cardiovascular death than those
randomized to placebo.
A
subgroup of patients with above average cholesterol who received standard
lipid-lowering therapy for 5.5 years had 21% fewer cardiovascular deaths over
ten years of follow-up with the newer blood pressure therapy compared to the
older one. There was a non-significant trend towards lower all-cause and stroke
deaths with the newer treatment.
These
findings hold significance for practicing doctors, as they provide confirmatory
evidence for the long-term beneficial effects of antihypertensive treatment
together with statin, especially with regard to mortality, which was earlier
only thought that they would. The benefits of BP- and lipid-lowering therapies
accumulate over time, even after treatment has been completed by the patient.
These findings are also pertinent for patients, as they encourage compliance to
treatment.
The
study therefore supports the use of an effective anti-hypertensive therapy
along with a statin in most patients with hypertensive and have the potential
for changing practice.
(Source:
ESC Press Release)
Dr KK
Aggarwal
Padma
Shri Awardee
Vice
President CMAAO
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Immediate
Past National President IMA
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