Gupta A, et al. - Researchers performed the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study reporting the all-cause and cardiovascular mortality after 16 years of follow-up of the UK based participants with hypertension in the original ASCOT trial. Findings suggest that antihypertensive treatment with a calcium channel blocker-based treatment regimen and lipid-lowering with a statin had the long-term beneficial effects on mortality: patients on amlodipine-based treatment had fewer stroke deaths and patients on atorvastatin had fewer cardiovascular deaths more than 10 years after trial closure.

Methods

• Researchers performed follow up of UK-based patients with hypertension, participated in ASCOT, for all-cause and cardiovascular mortality for a median of 15·7 years (IQR 9·7–16·4 years).
• At baseline, either amlodipine-based or atenolol-based blood pressure-lowering treatment was randomly administered to all the patients in the blood pressure-lowering arm (BPLA) of ASCOT.
• Under further randomisation, either atorvastatin or placebo was administered to the patients who had total cholesterol of 6·5 mmol/L or lower and no previous lipid-lowering treatment as part of the lipid-lowering arm (LLA) of ASCOT.
• The non-LLA group comprised the remaining patients.
• All causes of death was adjudicated by a team of two physicians independently.

Results

• ASCOT comprised 8580 UK-based patients; of these, 3282 (38·3%) died, including 1640 (38·4%) of 4275 assigned to atenolol-based treatment and 1642 (38·1%) of 4305 assigned to amlodipine-based treatment.
• In the LLA, death was reported for 1768 of the 4605 patients; these included 903 (39·5%) of 2288 assigned placebo and 865 (37·3%) of 2317 assigned atorvastatin.
• Of all deaths, cardiovascular-related death was reported for 1210 (36·9%) patients.
• Among patients in the BPLA, all-cause mortality was not different between treatment arms (adjusted hazard ratio [HR] 0·90, 95% CI 0·81–1·01, p=0·0776]), although significantly fewer deaths from stroke (adjusted HR 0·71, 0·53–0·97, p=0·0305) occurred in the amlodipine-based treatment group than in the atenolol-based treatment group.
• No interaction between treatment allocation in the BPLA and in the LLA was noted.
• However, in the 3975 patients in the non-LLA group, fewer cardiovascular deaths (adjusted HR 0·79, 0·67–0·93, p=0·0046) were reported among those assigned to amlodipine-based treatment compared with atenolol-based treatment (p=0·022 for the test for interaction between the two blood pressure treatments and allocation to LLA or not).
• In the LLA, patients assigned to statin showed significantly fewer cardiovascular deaths (HR 0·85, 0·72–0·99, p=0·0395) than those assigned placebo.