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Blood pressure medications and statins found to provide long-term cardiovascular benefits

Death rates from heart disease and stroke could be significantly lowered by prescribing statins alongside blood pressure-lowering drugs, according to the results from a clinical trial led by Queen Mary University of London and Imperial College London.

28 August 2018

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The findings, published today in The Lancet and presented at the European Society of Cardiology Congress in Munich, revealed that the benefits of statins lasted more than a decade after the clinical trial closed.

Dr Ajay Gupta from Queen Mary’s William Harvey Research Institute said: “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. 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 treatment effective enough to stop a clinical trial

The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) trial was set up to compare two separate treatments for high blood pressure. Between 1998 and 2000, over 19,000 patients in the UK, Ireland and Scandinavia with high blood pressure were randomly allocated to one of two blood pressure lowering treatments – one involving a calcium channel blocker, the other involving a beta-blocker.

Half of all those patients were then further randomised to receive a cholesterol-lowering statin or a placebo.

In 2003, the statin arm of the trial was stopped early after just over three years of follow up, because the statin proved to be highly beneficial in preventing heart attacks and strokes. These initital results influenced national and international guidelines for blood pressure treatment and lipid-lowering for people at risk of heart disease and stroke, including those produced by the UK’s health watchdog the National Institute for Health and Care Excellence.

This new analysis looked at the number and cause of deaths among the 8,580 participants in the ASCOT trial who were based in the UK and followed up until December 2015.

29 per cent fewer stroke-related deaths

After 16 years’ follow-up, a total of 3,282 patients had died. Of those originally treated with statins, there were 15 per cent fewer cardiovascular deaths compared with those originally assigned to the placebo arm of the trial.

After 10 years’ follow-up, the patients who were allocated to the calcium-channel blocker-based treatment were found to have 29 per cent fewer deaths due to stroke compared to those allocated to the beta blocker-based treatment. 

For those at higher cardiovascular risk who weren’t given statins, the calcium-channel based treatment was associated with 21 percent fewer cardiovascular related deaths.

Professor Peter Sever, from the National Heart and Lung Institute at Imperial College London, said: “We have previously shown that statins can confer long term benefits on mortality after trials have stopped, but to our knowledge it has never before been shown that for patients with high blood pressure there may be long term benefits on preventing cardiovascular deaths – particularly strokes in patients treated with a calcium chanel blocker-based regimen.”

Professor Mark Caulfield, Director of the William Harvey Research Institute at Queen Mary, said: “This study confirms the importance of lowering blood pressure and cholesterol to prevent disabling and life-shortening cardiovascular disease.”

The authors highlight, however, that there is a period of more than 10 years following the end of the trial where they do not have full data available for treatments patients may have been taking or prescribed.

The study was funded by Pfizer.  

More information

  • Research paper: ‘Long-term mortality after the blood pressure and lipid-lowering treatment in hypertensive patients: 16-year follow-up of the Anglo-Scandinavian Cardiovascular Outcomes Trial (ASCOT) Legacy study’ by Ajay Gupta et al. is published in The Lancet.