ASCOT study: consequences and lessons
Abstract
ASCOT study results influenced the content of the British National guidelines on arterial hypertension (AH) 2006 and the European Hypertension Society guidelines 2007. This study demonstrated that AH treatment with “new” antihypertensives (calcium antagonists, ACE inhibitors) is more effective and more metabolically safe than treatment with “old” agents (diuretics, beta-adrenoblockers). It has been shown that vessel organo-protection includes not only delaying atherosclerosis progression, but also decreasing arterial stiffness. Reducing blood pressure (BP) in aorta is more important than brachial BP decrease; arterial stiffness reduction is one of the crucial characteristics of antihypertensive medications. Despite lower effectiveness of beta-adrenoblockers in AH complication prevention, these agents still remain among main antihypertensive classes.
About the Author
S. A. BoytsovRussian Federation
References
1. Poulter N, Sever P. Anglo-Scandinavian Cardiac Outcomes Trial. History, results and implications for the management of high blood pressure. Birmingham: Sherborne Gibbs Ltd; 2005.
2. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke and coronary heart disease. Part 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827-38.
3. Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALL-HAT). JAMA 2002; 288: 2981-97.
4. 2003 Guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension and of the European Society of Cardiology. J Hypertens 2003; 21: 1011-53.
5. 2007 Guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-87.
6. Kjeldsen SE, Dahlof B, Devereux RB, et al. Losartan Intervention for Endpoint Reduction (LIFE) Study Group: Effect of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: Losartan Intervention for Endpoint Reduction (LIFE) substudy. JAMA 2002; 288: 1491-8.
7. London GM, Asmar RG, O,Rourke MF, Safar ME. REASON Project Investigators: Mechanism(s) of selective systolic blood pressure reduction after a low dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol. JACC 2004; 43: 92-9.
8. Franklin SS, Jacobs MJ, Wong ND, et al. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives. Analysis based jn National Health and nutrition ExaminationSurvey (NHANES) III. Hypertension 2001; 37: 869-74.
9. Laurent S, Cockcroft J, Bortel LV, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 2588-600.
10. Nichols WW, O’Rourke MF. McDonald’s blood flow in arteries: theoretic, experimental and clinical principles. 5th ed. Edward Arnold, London, 2005; 198p.
11. Lindholm LH, Carlberg B, Samuelsson O. Should E-blockers remain first choice in the treatment of primary hypertension? A meta-analysis. The Lancet 2005; 366:1545-53.
12. Bradley HA, Wiysonge CS, Volmink JA, et al. How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analisys. J Hypertens 2006; 24: 2131-41.
13. National Institute of Clinical Exellence (NICE) Clinical Guideline 34 – management of hypertension in adults in primary care, 2006. Available at: www.nice.org.uk. Accessed June 2006.
Review
For citations:
Boytsov S.A. ASCOT study: consequences and lessons. Cardiovascular Therapy and Prevention. 2007;6(6):91-97.
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