Coronary heart disease benefits from blood pressure and lipid-lowering.
BACKGROUND
We have reported the benefits of atorvastatin and of an amlodipine-based regimen on coronary heart disease (CHD) events in hypertensive patients in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). We report further analyses on the combined benefits of these interventions.


METHODS
19,342 hypertensive patients were randomised to either an amlodipine or an atenolol-based regimen in the ASCOT Blood Pressure-Lowering Arm (BPLA). 10,305 subjects with total cholesterol <or=6.5 mmol/L were further randomised to atorvastatin 10 mg or placebo in the Lipid-Lowering Arm (LLA). Estimates of CHD risk at baseline based on the Framingham algorithm were compared with observed and predicted event rates throughout ASCOT-LLA.


RESULTS
Estimated baseline Framingham risk of CHD events was 22.8 per 1000 patient years. After 3.3 years, when the LLA was stopped, the actual CHD event rate had fallen to 4.8 per 1000 patient years--a reduction of 79% in those assigned amlodipine-based treatment and atorvastatin.


CONCLUSIONS
CHD benefits associated with BP and lipid lowering were larger than predicted by previous observational and trial data. We estimate that compared with pre-trial treatment, treating about 55 patients with the amlodipine-based regimen and atorvastatin would prevent one CHD event per year.
Sever
Peter S
PS
Clinical Pharmacology and Therapeutics, Imperial College London, International Centre for Circulatory Health, London, UK. p.sever@imperial.ac.uk
Poulter
Neil R
NR
Mastorantonakis
Stylianos
S
Chang
Choon Lan
CL
Dahlof
Bjorn
B
Wedel
Hans
H
D017311:Amlodipine / Q000627:therapeutic use*; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D000069059:Atorvastatin; D001794:Blood Pressure / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D020913:Perindopril / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D049993:Sodium Chloride Symporter Inhibitors; D017311:Amlodipine; D001262:Atenolol; D000069059:Atorvastatin; D020913:Perindopril