New Treatment Strategy set to Revolutionise Hypertension Management

ASCOT data extends perindopril life saving benefits to all hypertensives

The management of hypertension is set to be turned on its head following new data presented today at the American College of Cardiology (ACC) Annual Scientific Sessions from the Anglo-Scandinavian Cardiac Outcomes Trial ( ASCOT )(1). The groundbreaking preliminary results indicate that the treatment combination of amlodipine and COVERSYL(R) (perindopril) significantly better than the current first-line treatment strategy of atenolol/bendroflumethiazide at reducing total mortality in patients with hypertension. In the UK , over 2 million hypertension patients are either on beta blockers, a diuretic or both. Over 900,000 of these are on atenolol or bendroflumethiazide monotherapy, and an additional 639,000 patients take the combination of the two.

"These results are hugely significant for the future management of hypertension", commented Professor Peter Sever, co-chairman of the steering committee. "The health benefits associated with perindopril/amlodipine compared with atenolol/bendroflumethiazide, raise concerns about the future place oft beta-blockers as first-line treatment choice for hypertension."

ASCOT is a major multi-national trial involving over 19,000 hypertensive patients that compared the effectiveness of two different treatment strategies in reducing cardiovascular events. The new treatment strategy (the angiotensin converting enzyme inhibitor, perindopril and the calcium channel blocker, amlodipine) was found to offer significant advantages over the older treatment strategy (the beta blocker, atenolol and the thiazide diuretic, bendroflumethiazide), to such an extent that the trial was stopped early by the ASCOT Steering Committee in December 2004. This is the first time that a hypertension trial has been stopped early due to a difference in all-cause mortality between two antihypertensive treatment regimens.

The study found that the perindopril/amlodipine treatment combination significantly reduced death by any cause, cardiovascular death, stroke (by around 25%), total coronary events (by around 15%) and new-onset diabetes, compared with the atenolol/bendroflumethiazide combination.

"The results of this trial are big news," remarked Dr Adrian Brady, consultant cardiologist at Glasgow Royal Infirmary. "Not only do they question the value of beta blockers as a first-line treatment for hypertension, they also add to the growing body of evidence for the beyond blood pressure-lowering effects of perindopril as previously demonstrated in studies such as EUROPA and PROGRESS."

Hypertension is a major risk factor for CHD and stroke, and perindopril already has significant evidence in patients who are already diagnosed with these conditions. In the EUROPA study,(2) in patients with CHD, the addition of perindopril to existing treatments brought a further 20% relative risk reduction in the combined endpoint of cardiovascular death, non-fatal MI and resuscitated cardiac arrest, while the PROGRESS study(3) showed that one out of 10 stroke sufferers given a therapy based on perindopril avoided either death, MI or further stroke over four years of treatment. The results of ASCOT extend the exciting benefits of perindopril to patients without evidence of cardiovascular disease, but who are hypertensive.

The final data will be presented and published later this year, and it is widely expected that hypertension guidelines will be reviewed in light of these results.

Notes

The ASCOT trial involves over 19,000 patients from the UK , Ireland and Scandinavia and is endorsed by the British Hypertension Society. All the patients had hypertension and at least three pre-specified cardiovascular risk factors such as being over 50 years old, being a smoker and having a family history of coronary events. The aim of the ASCOT trial was to test the hypothesis that a newer antihypertensive regimen is more effective than an older regimen in the primary prevention of coronary heart disease. The average length of treatment was about five and a half years. The full results of the ASCOT study are expected to be released in September 2005.

 References

  (1) Sever P, Dahlöf B, Poulter N et al. Rationale, design, methods and baseline demographs of participants of the Anglo-Scandinavian Cardiac Outcomes Trial. J Hypertens 2001;19:1139-1147

  (2) EUROPA Study Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782-788.

  (3) Randomised trial of the perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. PROGRESS collaborative group. Lancet  2001;358: 1033-41

  Source: Servier

 (9/3/05)