Imperial study influences national guidelines on blood pressure treatment

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-Disease Prevention Section

External Sites:
-ASCOT

-National Institute of Clinical Excellence

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By Tony Stephenson
Monday 3 July 2006

An Imperial study has significantly influenced new clinical guidelines for the treatment of patients with high blood pressure.

The new NICE (National Institute of Clinical Excellence) guidelines have been changed to reflect newer more effective treatment practices which came out of the Europe wide ASCOT (Anglo Scandinavian Cardiac Outcomes Trial).

ASCOT, which Imperial co-led with the University of Gothenburg, Sweden, found that a newer treatment could cut the risk of strokes by around 25 percent, and the risk of coronary events by around 15 percent.

The trial involved 19,000 patients and compared a new treatment strategy for high blood pressure against an older one, in order to discover which is better at preventing various cardiovascular events such as heart attacks and strokes.

The results of the trial, announced last year, showed that a treatment strategy using the calcium channel blocker, amlodipine, and the angiotensin converting enzyme inhibitor, perindopril, was more effective than the older treatment strategy based on the beta-blocker, atenolol and the thiazide diuretic, bendroflumethiazide.

Professor Peter Sever  from Imperial College London, and co-chairman of ASCOT, said: "The news that ASCOT has managed to influence national guidelines shows just how important trials such as these are. Blood pressure is the commonest risk factor contributing to the global burden of disease, and with a projected 1.5 billion sufferers of hypertension by 2020 it is vital that we take steps to tackle it. We hope these new guidelines will help reduce the burden of ill health and mortality across the UK."

Of over 19,000 patients randomised to the two different blood pressure strategies, approximately 10,000 patients were also randomised to treatment with either atorvastatin or placebo in the ASCOT Lipid Lowering Arm (ASCOT-LLA). The ASCOT-LLA was stopped prematurely in October 2002, as a result of substantial benefits associated with statin use in the prevention of heart attacks and strokes.

The remainder of the trial was stopped in 2004 after the Steering Committee of ASCOT accepted the recommendation of its Data Safety Monitoring Board that the blood pressure arm of the trial should be stopped, due to far better results for those patients on the new treatment.