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Statins Have Dramatic Effect On Hypertensives With Normal Cholesterol

Hypertensive patients with normal or only moderately raised cholesterol can benefit from statin treatment.

Statins reduce risks of myocardial infarction by some 36%, and stroke by some 25%, report clinicians with the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) among patients in Denmark, Finland, Norway, Sweden, Britain and Ireland. The benefit from the statin atorvastatin was so marked that this part of the multi-faceted trial was stopped early.

The cohort consisted of 10,305 hypertensive patients with non-fasting total cholesterol concentrations 6.5 mmol/L or less who were randomly assigned additional atorvastatin 10 mg or placebo, because no previous study has assessed statin use among hypertensive not considered dyslipidaemic. Patients were between the ages of 40 to 79, and with at least three other cardiovascular risk factors.

Five-year follow up was planned, but the trial was stopped after a median follow up of 3.3 years. Statin benefits were most evident at the first year: atorvastatin lowered total serum cholesterol by about 1.3 mmol/L compared with placebo at 12 months, and by 1.1 mmol/L after three years of follow- up.

Overall, there were 100 primary events among those receiving atorvastatin compared with 154 events among patients receiving placebo. There were 185 deaths in the atorvastatin group and 212 in the placebo group.

Among patients with fatal and non-fatal stroke, there were 89 among patients receiving atorvastatin, compared with 121 among those receiving placebo. There also were significant reductions in total cardiovascular events, with 389 among patient in the atorvastatin group compared with 486 among those receiving placebo, and total coronary events. 178 among the atorvastatin patients and 247 among the placebo group.

There has been much speculation as to whether statins reduce blood pressure, the clinicians said, but "no firm conclusions can be drawn from the ASCOT database since, by design, antihypertensive medication was titrated upwards based on achieved blood pressure, thereby potentially masking any impact of statin treatment on blood pressure."

"The impact of our assessment of the benefits of atorvastatin in hypertensive patients with other cardiovascular risk factors on the use of open-label lipid lowering treatment in the ASCOT cohort overall and among the hypertensive population in general remains to be seen."

They concluded with the hope that their results "will help to close the gap between what is recommended and the current suboptimal use of lipid-lowering treatment in clinical practice."
Lancet 2003;[http://image.thelancet.com/extras/03art3046web.pdf].

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