A European team of scientists have found that there is a lower risk of developing cardiovascular disease if a patient is taking drugs to lower their cholesterol and blood pressure levels. The team presented the study at European Society of Cardiology (ESC) Congress, 2018 and also published their findings in The Lancet. An abstract of the study is available to read online.
The study was the result of a long-term follow-up of a study in which 8580 UK patients were recruited as part of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) which recruited patients between 1998 and 2000, who had been diagnosed with high blood pressure and also had three or more other risk factors for cardiovascular disease.
High blood pressure and high low-density lipoprotein or ‘bad’ cholesterol has been proven through many studies to be risk factors for heart disease and increased risk of strokes. The cholesterol can lead to the build-up of fatty deposits in the arteries which can block them. Statins are used to lower the body’s cholesterol levels and blood pressure drugs can help to bring a patient’s blood pressure to more normal levels. This study, however was the first time that the drugs had been combined and the results studied.
The original ASCOT trial had 3 main aims: the first was to examine whether a new strategy for reducing hypertension and therefore helping to prevent heart attacks was more effective than an old strategy. Patients were either assigned to a new treatment which included amplodipine, which is a calcium channel blocker, and perindopril which is an angiotensin-converting enzyme inhibitor, which was added if needed to help reduce the blood pressure to the desired target. The older strategy included using atenolol which is a beta-blocker, bendroflumethiaszide (a diuretic) and, if needed, potassium. The drugs were followed for an average of 5.5 years, but the trial was stopped because the the newer treatment was proving much more effective in preventing stroke and death. Following the trial, patients were moved back to routine care.
The second aim was to examine whether a statin could provide added protection against coronary heart disease in patients with high blood pressure and cholesterol levels (above 6.5 mmol/L). The patients were split into two groups: one where they were allocated to atorvastatin or a placebo for 3.3 years. Again, the trial was halted, prematurely because the drug was being shown to prevent more stroke and heart attack. for the remainder of the trial, all the patients were offered the drug.
The trial also aimed to evaluate how effective the old blood pressure lowering treatment was when compared against a newer treatment for patients who had both high blood pressure and high cholesterol. These patients were not randomised and everyone received the standard therapy for 5.5 years.
The scientists concluded that the study was important because of it showed how effective preventative medicine could be. It suggested that lowering both cholesterol and blood pressure could help prevent cardiovascular disease. Patients who had taken both cholesterol-lowering drugs and statins for 5.5 years were shown to have a 29% lower risk of dying from a stroke, 10 years later than those who took traditional blood pressure drugs.
Patients who had average cholesterol levels at the beginning of the trial and who were taking a statin, had a 15% lower risk of dying from cardiovascular disease or stroke after 16 years when compared with the placebo group.
Those patients who had high cholesterol at the start of the trial, who took their usual drugs to lower cholesterol and new blood pressure drugs were 21% less likely to die from cardiovascular disease over 10 years.
In the UK, patients are offered a health check every 5 years when they are 40 years of age. This health check includes cholesterol and blood pressure and patients may be put on blood pressure tablets or statins if they need it.
It is important to see your GP if you feel unwell.
Gupta, A, MRCP., 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, The Lancet, September 2018, Vol.392, Issue 10153, pp1127-1137
British Heart Foundation Heart Matters Magazine offers some informative articles on the subject of high blood pressure and high cholesterol
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