Première démonstration d'une supériorite des agents antihypertenseurs modernes par rapport aux molécules plus anciennes dans la prévention cardio-vasculaire : résultats du bras "abaissement de pression artérielle" de l'étude ASCOT

In the antihypertensive population, a normalisation of blood pressure level must be the first objective. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) - Blood Pressure lowering arm again confirms this assertion. The benefit has been proportional to the blood pressure decrease. However, the use of newest antihypertensive drugs (the long acting dihydropyridine calcium antagonist amlodipine very often associated to the ACE inhibitor perindopril) in the hypertensive population aged from 40 to 79 years with at least 3 additional risk factors showed significantly lower rates of cardiovascular and total mortalities, cardiovascular events, new diabetes or renal impairment as compared to the atenolol-based combination drug regimen (with thiazide as required). It should be noted that almost all the patients also received a low dose of a hypolipidemic drug, atorvastatin. Both arms (the statin arm and the arm using antihypertensive drugs) have yet been stopped, after 3 and 5 years, respectively related to the large beneficial effects noted with the new antihypertensive and statin treatments, although the primary endpoints (non fatal myocardial infarctival and fatal coronary heart disease) were not reached. This study raises many unsolved questions about the explanation for such benefits or the future management of the hypertensive people whose characteristics were very similar to those people frequently encountered in clinical practice. However, the present study emphasizes the considerable efficacy of a combination of amlodipine-perindopril and a low dose of statin.