Blood Pressure and Cholesterol-lowering Drugs Continue to Improve Survival After a Decade

Patients in their mid-60s with high blood pressure were less likely to die from heart disease or stroke by age 75-80 if they had taken both calcium channel blocker-based blood pressure lowering treatment and a statin. Patients with high blood pressure and three or more additional risk factors for cardiovascular disease.

Patients who took a newer blood pressure lowering treatment (based on a calcium channel blocker) for 5.5 years were 29 percent less likely to have died from a stroke 10 years later than those taking an older regimen (based on a beta-blocker). There was a non-significant trend towards 10 percent fewer cardiovascular deaths with the newer therapy. We have previously shown that statins confer long-term survival benefits after trials have stopped, but this is the first time it has been found with a blood pressure treatment, says the researcher.

The findings provide further support for the use of an effective blood pressure lowering therapy plus a statin in most patients with high blood pressure. 

• A main objective of the initial ASCOT trial was to find out whether a new treatment strategy for high blood pressure was more effective in preventing heart attacks than an old strategy. Patients with high blood pressure were randomly allocated to:
• The new treatment of amlodipine (a calcium channel blocker) plus perindopril (an angiotensin-converting enzyme inhibitor) if needed to achieve the target blood pressure; or
• The old therapy of atenolol (a beta-blocker) plus bendroflumethiazide (a diuretic) and potassium if needed.

The medicines were taken for a median of 5.5 years when the trial was stopped because the newer treatment prevented more strokes and deaths.

• A second aim of the trial was to discover if a statin would provide added protection against coronary heart disease in patients with high blood pressure and cholesterol levels below 6.5 mmol/L. Patients with a blood cholesterol level of 6.5 mmol/l or less were randomly allocated to atorvastatin or placebo for 3.3 years when the trial was prematurely stopped because atorvastatin prevented more heart attacks and strokes.

• A third aim of the trial was to evaluate the effectiveness of the newer versus older blood pressure lowering treatment in patients with high blood pressure and high cholesterol (above 6.5 mmol/l).