Breaking news from an international cardiology congress offers hope for public health specialists in the Middle East that the rising epidemic of diabetes could be held in place by the correct treatment regimen.
Results from the analysis of the landmark Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) showed that patients with high blood pressure (hypertension) and additional cardiovascular risk factors who received a treatment regimen based on a calcium channel blocker were a third less likely to develop new-onset diabetes, compared with patients who received the standard beta-blocker based regimen.
The results were presented last night at the meeting of the World Cardiology Congress (WCC) in Barcelona, Spain.
“The findings from ASCOT presented today demonstrate that a Norvasc-based (amlodipine besylate) antihypertensive regimen may reduce the risk of developing diabetes compared to a beta blocker based regimen. The results are clinically important as patients who are hypertensive and diabetic are at a much greater risk for developing cardiovascular disease,” a leading cardiologist told the conference.
The five-year ASCOT Study, which was one of the largest hypertension trials ever conducted, involved more than 19,000 patients in Northern Europe who had hypertension and at least 3 other risk factors.
Of the 19,257 patients recruited into the study, 14,120 were considered to be non-diabetic at the start. However, during the trial 1,366 patients subsequently developed new-onset diabetes.
Observational clinical data suggests that hypertension is a risk factor for type II diabetes and so the two conditions often coexist. Greater blood pressure control is recommended by guidelines for patients with both hypertension and diabetes. Since diabetics are more likely to suffer a CV event, the particular choice of antihypertensive regimen can influence the CV outcome.
Hypertension is one of the most prevalent risk factors for cardiovascular disease, affecting as many as 800 million people worldwide. It is estimated that at least 80 percent of people with high blood pressure may also have other uncontrolled cardiovascular risk factors with elevated cholesterol being the most common.
Background on the ASCOT Study
The final results of the ASCOT Blood Pressure Lowering Arm were presented at the European Society of Cardiology in 2005 and showed an 11 percent reduction in total mortality in patients taking the Norvasc-based regimen compared with patients taking the beta-blocker based regimen. Patients receiving the Norvasc regimen also experienced a 23 percent reduction in fatal and non-fatal strokes and a 24 percent reduction in cardiovascular death, compared to patients taking the beta-blocker-based regimen.
In addition to being treated for high blood pressure, 10,000 patients in ASCOT who had normal to mildly elevated cholesterol levels -- not typical candidates for lipid-lowering treatment -- received Lipitor 10mg (atorvastatin calcium) or placebo to evaluate the cardiovascular benefits of lipid-lowering therapy. In October
2002, the lipid-lowering arm of ASCOT was stopped earlier than expected due to a significant benefit in the reduction of heart attacks in Lipitor-treated patients.
The results of the lipid-lowering arm of ASCOT provided critical information in the development of guidelines including the Joint European Guidelines, which now call for more aggressive lipid lowering in patients who have elevated cardiovascular risk, including patients with high blood pressure.
The study began in 1998 and enrolled patients in the United Kingdom, Ireland, Sweden, Norway, Denmark, Finland and Iceland. In November 2004, the ASCOT steering committee endorsed the recommendation of the Data and Safety Monitoring Board to stop the trial early due to favorable benefits, including mortality, demonstrated in patients who received the Norvasc-based regimen.
