[Statin therapy for hypertensive patients]

Abstract

Background: The majority of cardiovascular events and deaths attributable to both raised blood pressure and dyslipidaemia occur in subjects with relatively "normal" blood pressure and lipid levels respectively. The study was designed to evaluate the potential benefits of cholesterol lowering in the primary prevention of coronary heart disease in hypertensive subjects with average and below average levels of serum cholesterol.

Material and methods: Out of 19 342 hypertensive subjects (aged 40-79) who were initially randomized to one of two antihypertensive treatment strategies in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), 10 305 subjects with total cholesterol levels < or = 6.5 mmol/L were additionally randomized to either 10 mg atorvastatin or placebo. The primary endpoint was non-fatal myocardial infarction or fatal coronary heart disease.

Results: The lipid arm of the study was prematurely stopped after a median follow-up period of 3.3 years. One hundred events occurred in those randomized to atorvastatin compared to 154 events in those receiving placebo, a 36 % relative risk reduction (p = 0.0005) in the primary endpoint. Among secondary and tertiary endpoints, stroke was reduced with 27% (p = 0.02). There was a non-significant 13% reduction in total mortality. Non-cardiovascular mortality was similar in the two treatment limbs of the trial. After three years of follow-up, atorvastatin lowered total serum cholesterol by 1.1 mmol/L compared with placebo.

Interpretation: Treatment with 10 mg atorvastatin o.d. in hypertensive patients at moderate risk gives a significant risk reduction of coronary heart disease, independent of baseline level of total cholesterol.