Hypertension and cholesterol: Do treatments reduce mortality?

The validity of treatments for hypertension and cholesterol are often questioned by various self-proclaimed experts. It is therefore interesting to look at the scientific data available to take stock.

Do you really need to treat high blood pressure or high cholesterol? This question is recurrent and the validity of their treatment is frequently called into question by various self-proclaimed experts. That's why it's interesting to look at the science that's available.

The very long follow-up of a study having tested these treatments in a validated framework confirms the effectiveness on the cardiovascular mortality of a reduction of the arterial hypertension and the cholesterol level in the blood. In addition, among antihypertensives, it appears that a calcium channel blocker specifically reduces the risk of death from stroke. In the same way, the analysis shows that a statin particularly reduces the risk of death from coronary disease. It is therefore possible to precisely adjust the treatment according to the predominant risk.

HTA and cholesterol: 2 silent risk factors

Hypertension (normal blood pressure is less than 140-90 mmHg) is a major risk factor for cardiovascular diseases (coronary insufficiency, stroke, renal failure, heart failure, arterial aneurysm, aortic dissection, arrhythmia, dementia ...) ... The professionals even call her the "silent killer", adds Pr Claire Mounier-Vehier, cardiologist and president of the French Federation of Cardiology, before continuing: "the disease is most often silent but can be manifested by a set of Nonspecific symptoms: tiredness, morning headaches, dizziness, flies in the eyes, tinnitus, palpitations, poor concentration, and a feeling of oppressed chest are all signs of the disease. "

The same goes for excess cholesterol in the blood that will gradually clog the arteries "as tartar settles on the wall of plumbing pipes when there is too much limestone in the water". In cases of hypercholesterolemia, true plaques of atherosclerosis are deposited on the inner wall of our arteries. They enlarge gradually but can ulcerate and in this case a clot is formed and the artery can be clogged brutally, leading to the vascular accident at the level of a coronary artery (infarction), an artery of the brain (accident cerebrovascular) or another.

16 years after the start of treatment

In hypertensive patients, the long-term effects on mortality of different hypotensive and lipid-lowering regimens are not well documented. To mitigate this, the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) study analyzed the mortality of British patients 16 years after the start of their treatment in this study.
Initially, all patients enrolled in the hypotensive treatment group were randomly assigned to treatment with amlodipine (calcium channel blocker) or atenololol (beta-blocker) to lower blood pressure. Of those patients, those who had a total cholesterol level of 6 to 5 mmol / L or less (ie a moderate level) and who had never received a lipid-lowering treatment had an additional draw. to test the interest of a cholesterol-lowering treatment in addition. He received either atorvastatin (statin) or placebo as part of the lipid-lowering arm. A team of two doctors judged all the causes of death without knowing in which treatment group the patients had been drawn.

The long-term benefits

Of the 8,580 UK patients participating in the ASCOT study, 3,282 (38% to 3%) died after 16 years, including 1,640 (38.4%) of the 4,275 patients treated with atenololol. and 1,642 (38.1%) of the 4305 patients treated with amlodipine. 1,668 of the 4,605 ​​cholesterol-lowering patients died, including 903 (39.5%) of the 2,288 patients who received the placebo and 865 (37.3%) of the 2,217 patients who received atorvastatin. Of all deaths, 1,210 (36 to 9%) were from cardiovascular causes.

At age 16, there is no overall difference in all-cause mortality between the 2 antihypertensive treatments, although the number of stroke deaths is much lower in the amlodipine group than in the group who received atenolol. There is no interaction between the effect of hypotensive treatments and that of cholesterol-lowering treatment. On the other hand, in patients treated with statins, the number of cardiovascular (and in particular coronary) deaths was significantly lower than in placebo patients.

Proven reduction in mortality under treatment

"Our results show the long-term beneficial effects on mortality of antihypertensive therapy with calcium channel blockers and statin-based lipid-lowering therapy, with fewer patients receiving amlodipine Stroke and patients under atorvastatin fewer cardiovascular deaths more than 10 years after the end of the trials, "say the researchers.

"Overall, the ASCOT study supports the idea that interventions for high blood pressure and high cholesterol are associated with long-term benefits for cardiovascular events," they conclude.

Video: Complications of High Blood Pressure. Nucleus Health (January 2020).