Antihypertensive treatment plus a statin has long-term mortality benefits

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