Data alert

ASCOT: New Insights on Aggressive Risk Factor Intervention to Prevent Major CV Events In Hypertensive Patients

Cardiovascular (CV) disease remains the leading cause of death in the United States, claiming more lives each year than the next four leading causes of death combined.1 Clearly, this justifies a search for conditions that contribute to CV disease risk. Hypertension and hyperlipidemia are extremely common conditions that often coexist, and when they do, the odds for cardiac events are multiplied.2,3 For example, in the Framingham Heart Study, when blood pressure (BP) >120 mg/80 mm Hg and cholesterol (total-C) >200 mg/dL coexisted, the risk for CV events increased exponentially. Among men aged 40 to 59 years at baseline who died of coronary heart disease (CHD), 87% had BP >120/80 mm Hg and 92% had a total-C level >200 mg/dL.2

The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), a study of BP- and lipid-lowering in over 19,000 patients, provides compelling new evidence of the importance of aggressive risk factor intervention to prevent major CV events in patients with hypertension.4-7 Previously, Steno-2, a study in 160 patients with diabetes and microalbuminuria, demonstrated that aggressive target-driven treatment to simultaneously lower BP, glucose, total-C, and triglycerides produced a 53% reduction in CV death, nonfatal myocardial infarction (MI) or stroke, revascularization, and amputation over 7.8 years compared with usual care.8

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ASCOT and Steno-2: Aggressive risk reduction benefits two different patient populations

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ASCOT and Steno-2: Aggressive risk reduction benefits two different patient populations ASCOT: Patients had hypertension and ≥3 other risk factors, fitting a common clinical profile ASCOT-BPLA: Reduction in primary outcome (nonfatal MI and fatal CHD) ASCOT: Risk reductions with the amlodipine/perindopril regimen CAFE asked whether newer vs older BP treatments have differing effects on central aortic BP CAFE: Central aortic pressure is lower with the amlodipine/perindopril regimen CAFE: Lesser ability of β-blockers to reduce augmentation wave ASCOT: Lipid lowering is beneficial regardless of baseline cholesterol level ASCOT: Greater gain with statin + CCB/ACE inhibitor vs statin + β-blocker/diuretic

References are listed at the end of the Data Alert.


Related at vwbg.org

ASCOT-LLA: Extending benefits of statins to hypertensive patients

Hypertension and hypercholesterolemia frequently coexist and the interaction of these important risk factors increases cardiovascular risk considerably.

Results from ASCOT-BPLA: A nglo- S candinavian C ardiac O utcomes T rial-Blood Pressure Lowering Arm

ASCOT-BPLA compared two combination antihypertensive regimens in 19,257 hypertensive patients with 3 or more other CV risk factors.

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