A total of 19 257 hypertensive subjects were randomized to an
amlodipine-based regimen or an
atenolol-based regimen. Of these, 10 305 subjects with total
cholesterol < or =6.5 mmol/L were further randomized to
atorvastatin 10 mg daily or placebo. In this analysis, the effects of
atorvastatin were compared with placebo on
coronary heart disease (CHD), cardiovascular and
stroke events in those assigned
amlodipine-based and
atenolol-based regimens. In the ASCOT
lipid-lowering arm (LLA), overall,
atorvastatin reduced the relative risk of the primary endpoint of non-fatal
myocardial infarction and fatal CHD events by 36% (HR 0.64, CI 0.50-0.83, P=0.0005), total cardiovascular events by 21% (HR 0.79, CI 0.69-0.90, P=0.0005), and
stroke by 27% (HR 0.73, CI 0.56-0.96, P=0.024). However,
atorvastatin reduced the relative risk of CHD events by 53% (HR 0.47, CI 0.32-0.69, P<0.0001) among those allocated the
amlodipine-based regimen, and by 16% (HR 0.84, CI 0.60-1.17, p: n.s.) among those allocated the
atenolol-based regimen (P=0.025 for heterogeneity). There were no significant differences between the effects of
atorvastatin on total cardiovascular events or
strokes among those assigned
amlodipine (HR 0.73, CI 0.60-0.88, P<0.005 and HR 0.69, CI 0.45-1.06, P: n.s., respectively) or
atenolol (HR 0.85, CI 0.71-1.02, P: n.s and HR 0.76, CI 0.53-1.08, P: n.s, respectively). Differences in blood pressure and
lipid parameters (placebo corrected) between the two
antihypertensive treatment limbs could not account for the differences observed in CHD outcome.
CONCLUSION: