Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT): blood pressure changes at 2.5 years of follow-up

On behalf of the ASCOT Steering Committee and Investigators. ASCOT is designed to test two primary hypotheses:- that an antihypertensive regimen based on a calcium channel blocker/angiotensin converting enzyme inhibitor regimen will confer greater protection against nonfatal myocardial infarction and fatal coronary heart disease than a regimen based on a beta-blocker/ diuretic; and that lipid lowering with a statin in a subgroup of patients with total cholesterol < 6.5 mmol/l compared with placebo will significantly reduce the same coronary heart disease end points. By May 2000 recruitment ended when 19342 patients with hypertension and at least 3 additional cardiovascular risk factors had been randomised into the trial and their demographics were recently reported (J.Hypertension 2001;19:1139–47). Mean blood pressures at randomisation (representing a mixture of both untreated 20% and previously treated 80% patients) were 164 mmHg systolic and 95 mmHg diastolic. Target pressures are<140 mmHg systolic and <90 mmHg diastolic, except for a subgroup of patients with type 2 diabetes in whom targets are lowered to <130 mm Hg systolic and <80 mmHg diastolic. Blood pressure changes during the first 2.5 years of follow up (treatment groups combined) are shown in the accompanying table. Patients will be followed up for a further 2.5 years on average. Mean BP & BP change by visit-all patients By 2.5 years 27 % of patients remained on one antihypertensive drug and the remainder (73%) required 2 or more antihypertensive drugs. These data emphasize that to achieve currently recommended BP targets, at least 2 drugs are required for most hypertensives but that using clear treatment algorithms as in the ASCOT trial, acceptable BP control is achievable for a large proportion of patients.