ASCOT Legacy: Long-Term Benefits of BP, Cholesterol Management on HTN

Interventions for blood pressure and cholesterol are associated with long-term benefits in patients with hypertension and no previous history of a coronary event, based on findings from the ASCOT Legacy Study. The study, presented Aug. 26 at ESC Congress 2018 and simultaneously published in The Lancet, looks at mortality outcomes from the UK cohort of the original ASCOT Study 16 years later.

As part of the ASCOT study, all 8,580 UK-based patients with hypertension were randomly assigned to receive either amlodipine-based (N=4,305) or atenolol-based (N=4,275) blood pressure-lowering treatment. Of these patients, those who had total cholesterol of 6.5 mmol/L or lower and no previous lipid-lowering treatment underwent further randomization to receive either atorvastatin (N=2,317) or placebo (N=2,288). Sixteen years later 1,640 patients assigned to atenolol-based treatment and 1,642 patients assigned to amlodipine-based treatment had died, while 865 of those patients also assigned atorvastatin and 903 patients assigned placebo also died.

Researchers noted that among patients receiving blood pressure-lowering treatment, there was no overall difference in all-cause mortality. However, there were significantly fewer stroke deaths in the amlodipine-based treatment group compared with the atenolol group. There were also fewer cardiovascular deaths in patients in the amlodipine group who were not also receiving lipid-lowering treatment. In those receiving lipid-lowering treatment, there were significantly fewer cardiovascular deaths among patients taking a statin vs. those taking placebo.

"This study is, to our knowledge, the first to report that both blood pressure-lowering and lipid-lowering treatments confer such long-term benefits," researchers said. "Furthermore, our findings from the non-lipid-lowering arm of the trial, a subgroup at higher cardiovascular risk at baseline, showed that these patients also receive significant long-term benefits from blood pressure-lowering therapies."

A related editorial comment notes that "the findings of the ASCOT Legacy study have important implications for future long-term follow-up studies of clinical trial participants," but the current inability to capture non-fatal cardiovascular disease outcomes of participants makes it difficult "to accurately predict how different treatments will affect specific groups." The editorial suggests "the need to establish registries to permit long-term assessment of morbidity and mortality in participants involved in randomized controlled trials of interventions for cardiovascular disease." It also notes that electronic health records can also facilitate this process, provided national regulations are established.

Keywords: ESC18, ESC Congress, Hypertension, Longitudinal Studies, Lipids

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