The Anglo‐Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm

Cardiovascular disorders, particularly coronary artery and cerebrovascular disease, are the major causes of death in the developed countries of the world (1). Many patients with these disorders either die suddenly or have a very short terminal illness and succumb before they can reach hospital (2). Others whose final illness is either heart failure or a stroke are left severely disabled and medical intervention is only modestly effective. For all these reasons prophylactic measures to reduce the risk of sudden death or serious disability, and directed at those at high risk or who have evidence of vascular disease, are of paramount importance. The three most important potentially modifiable risk factors for cardiovascular disease are hypertension (3, 4), hyperlipidaemia (5) and smoking (6). Effective lowering of blood pressure (7), plasma cholesterol (8) (particularly LDL cholesterol) and smoking cessation (9, 10) reduce risk and save lives. These and all other recognized and modifiable risk factors should be addressed to achieve the greatest possible impact. There is good evidence to show that the better the blood pressure is controlled, the greater the impact on cardiovascular mortality and morbidity (7, 11, 12). However, that still leaves many questions: e.g. (i) Should doctors and other healthcare workers choose to use antihypertensive regimens which have been shown not only to reduce blood pressure (the surrogate endpoint) but also to reduce cardiovascular mortality and morbidity? (ii) Are some regimens more effective than others, achieving a greater impact on clinical endpoints when having a comparable effect on blood pressure? The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and specifically its Blood Pressure Lowering Arm (ASCOT BPLA) was designed and performed to answer these two questions.