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Study shows long-term survival benefits of blood pressure and lipid-lowering therapies

By Nicole MacKee
Blood pressure and lipid-lowering therapies may improve the survival of hypertensive patients for more than a decade after active treatment, say UK researchers, but an Australian expert warns that such success in the ‘real world’ remains elusive.

The findings of the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Legacy Study – a 16-year follow up of 8580 UK-based participants with hypertension – were published in The Lancet and presented at the recent European Society of Cardiology Congress in Munich.

The researchers reported that participants on a calcium channel blocker-based treatment regimen for 5.5 years were 29% less likely to have a stroke-related death in the subsequent decade than patients taking a beta blocker-based regimen. They also found that among participants with total cholesterol of 6.5 mmol/L or lower, cardiovascular deaths were 15% less likely in those who took a statin for 3.3 to 5.5 years than in those who were randomised to placebo.

Professor Garry Jennings, the Heart Foundation’s Chief Medical Advisor, said legacy studies were difficult to interpret because patient care after the study period was largely unknown, and it was likely that many patients were switched to calcium channel blocker therapy after the trial.

Also, he told Cardiology Today, the survival benefits shown in the study did not necessarily reflect the ‘real world’ experience.

‘There are plenty of challenges still in blood pressure and lipid management,’ said Professor Jennings, pointing to problems of nonattendance and nonadherence to therapy in the community setting. ‘It’s not so much that we don’t have the tools, but we are not hitting the targets that we’re setting, and we are not achieving the success in the real world that this trial suggests we can.’

The findings could help clinicians to talk to their patients about the advantages of medication adherence, he said.

‘This [study] emphasises the real benefits of bringing blood pressure down to optimum levels in terms of the quality of their life,’ he said. ‘Everybody is scared of having a stroke.’
Lancet 2018; http://dx.doi.org/10.1016/S0140-6736(18)31776-8.