PracticeUpdate Cardiology Best of 2018

CONFERENCE COVERAGE 22

2018 European Society of Cardiology Congress 25–29 AUGUST 2018 • MUNICH, GERMANY By the PracticeUpdate Editorial Team

© ESC Congress 2018 – European Society of Cardiology

In PatientsWith Hypertension, Antihypertensives and Statins Continue to Improve Survival Effective antihypertensive therapy + a statin are further supported for most patients with high blood pressure. A fter more than a decade of treatment, antihypertensives and statins have been shown to continue to improve ASCOT Legacy is the long-term follow-up study of 8580 UK patients who took part in ASCOT.

for 5.5 years were 29% less likely to have died from stroke 10 years later than those taking a β-blocker. A nonsignificant trend toward 10% fewer cardiovascular deaths was observed with calcium channel blockers. Patients with an average (6.5 mmol/L) or below-average cholesterol level at the start of the trial who took a statin for 3.3–5.5 years were 15% less likely to have died of cardiovascular disease 16 years later than those randomized to placebo. A subgroup of patients with an above- average cholesterol level who received a statin for 5.5 years experienced 21% fewer cardiovascular deaths over 10 years with calcium channel vs beta-blockade. A nonsignificant trend toward lower all- cause and stroke deaths was observed with calcium channel blockade. Patients were randomized to the calcium channel blocker amlodipine + the angioten- sin-converting enzyme inhibitor perindopril if needed to achieve target blood pressure, or the β-blocker atenolol + the diuretic bendroflumethiazide and potassium if needed. The agents were taken for a median of 5.5 years when the trial was stopped because amlodipine-perindopril prevented more

survival in patients with hypertension. This conclusion, based on results of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study, was presented at ESC 2018. In an ESC press release, Ajay K. Gupta, MD, MBBS, PhD, MSc, of the William Harvey Research Institute, Queen Mary University, London, UK, said, “The findings provide fur- ther support for the use of an effective blood pressure lowering therapy plus a statin in most patients with high blood pressure.” He continued, “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 chan- nel blocker-based blood pressure lowering treatment and a statin.” Coinvestigator Peter Sever, MB, PhD, BChir, MA, of the National Heart and Lung Insti- tute in Imperial College London, UK, said, “These results are remarkable. 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.”

ASCOT was a prospective, randomized, open-label trial with a blinded endpoint and a double-blind 2 × 2 factorial component in patients with high blood pressure and three or more additional risk factors for car- diovascular disease. ASCOT tested the primary hypothesis that the calcium channel blocker amlodipine (with perindopril as required) would be more effective for preventing coronary heart disease than the β-blocker atenolol (with or without a diuretic). Between 1998 and 2000, patients with hypertension in the UK, Ireland, and Nor- dic countries (n=19,342) were randomized within the blood pressure-lowering arm. Patients with total cholesterol <6.5 mmol/L and not receiving a statin (n=10,305) under- went further randomization to atorvastatin or placebo as part of ASCOT’s lipid-lower- ing arm, which tested the second primary hypothesis that the addition of atorvas- tatin-based lipid-lowering would provide further protection against coronary heart disease endpoints. Patients who took a calcium channel blocker

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