Eagerly awaited final results of the five-year, 19,000-patient ASCOT study demonstrate that the combination of the newer blood-pressure-lowering drugs – Pfizer’s calcium channel blocker Norvasc (amlodipine) and Servier’s ACE inhibitor Coversyl (perindopril) with Pfizer’s Lipitor (atorvastatin) to lower cholesterol is more effective than standard treatment with a beta-blocker and a diuretic in reducing the risks of stroke and heart attack in people with high blood pressure considered at moderate cardiovascular risk. This largest-ever European study of high blood pressure treatment was presented on 4 September at the European Society of Cardiology meeting in Stockholm, and has been published in the latest issue of The Lancet.

The final results showed an 11% reduction in total mortality in patients taking the Norvasc, Coversyl, Lipitor-based regimen compared to patients in the beta-blocker group. Furthermore, those in the triple regimen arm witnessed a 23% reduction in fatal and non-fatal strokes and a 24% reduction in cardiovascular death – above and beyond that experienced by beta-blocker receivers.

There has been much debate about the reasons for ASCOT’s results, but there seems general agreement in Stockholm that ASCOT will change the way doctors treat high blood pressure. Beta-blockers and diuretics have been standard treatment for many years, but doctors will in future be more likely to use newer drugs as their first choice. In addition, because of increased risks of diabetes and impaired kidney function seen with beta-blockers in ASCOT, doctors will be reluctant to prescribe these drugs to patients at moderate risk, though they will still be valuable in high-risk patients with established cardiovascular disease. Use of statins is also likely to grow, given the extra benefits seen when Lipitor was added to treatment to lower blood pressure, even in patients with average or below average cholesterol levels at the start of the study.

As a result, ASCOT is likely to further raise the profile of Pfizer’s Norvasc and Lipitor as well Servier’s Coversyl, and there may also be a boost for other drugs, including the angiotensin II antagonists. The outcome for Governments may be short-term increases in healthcare costs, but ASCOT investigators believe that these will be more than offset by longer-term savings resulting from fewer heart attacks and strokes.

By Sue Lyon in Stockholm.