Statins, CCBs Confer Long-Term Mortality Benefit in Hypertension

Atorvastatin- and amlodipine-based antihypertensive treatments are associated with significant long-term reductions in cardiovascular death and stroke death, respectively, in patients with hypertension, with mortality benefits observed beyond 10 years of treatment, according to a study presented at the European Society of Cardiology in Munich, Germany, and simultaneously published in the Lancet.

In the 16-year follow-up of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy, researchers evaluated the long-term mortality outcomes of patients with hypertension who received calcium channel blocker-based treatments and lipid-lowering statin therapies. Patients based in the United Kingdom were followed for a median of 15.7 years (interquartile range, 9.7-16.4 years), and all-cause and cardiovascular mortality outcomes were recorded.

Participants who enrolled in the blood pressure-lowering group were randomly assigned to either amlodipine-based (n=4305) or atenolol-based blood pressure-lowering treatment (n=4275). Those in the blood pressure-lowering group with a total cholesterol level ≤6.5 mmol/L and no history of lipid-lowering therapy were then randomly assigned to either atorvastatin (n=2317) or placebo (n=2288) in the lipid-lowering study group (LLA). All other patients were allocated to the non-LLA group.

During the study period, approximately 38.3% of all participants died, including 38.4% randomly assigned to atenolol-based treatment, 38.1% assigned to amlodipine-based treatment, 37.3% assigned to atorvastatin, and 39.5% assigned to placebo. Cardiovascular-related causes of mortality were reported in 36.9% of all deaths.

No significant differences in all-cause mortality were observed between the treatment in the blood pressure-lowering group (adjusted hazard ratio [HR], 0.90; 95% CI, 0.81-1.01; P =.0776). Amlodipine-based treatment regimens, however, were associated with fewer stroke-related mortality events compared with atenolol-based blood pressure-lowering therapy (adjusted HR, 0.71; 95% CI, 0.53-0.97; P =.0305).

Significantly fewer cardiovascular deaths were observed in patients randomly assigned to amlodipine- vs atenolol-based therapies in the non-LLA group (adjusted HR, 0.79; 95% CI, 0.67-0.93; P =.0046). In addition, fewer cardiovascular deaths occurred in patients randomly assigned to statin therapy vs placebo in the LLA group (HR, 0.85; 95% CI, 0.72-0.99; P =.0395).

The lack of data on morbidity and additional therapies taken by participants at and after the trial’s closure represent potential limitations of the analysis.

Overall, findings from the ASCOT trial “contribute to evidence to support the long-term benefits of statins for reducing cardiovascular mortality” and “support the notion that interventions for blood pressure and cholesterol are associated with long-term benefits for cardiovascular outcomes.”

Reference

Gupta A, Mackay J, Whitehouse A, et al. Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial [published online August 26, 2018]. Lancet. doi:10.1016/S0140-6736(18)31776-8