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HOPE-3: Antihypertensive treatment benefits patients with poor lifestyle
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A BP-lowering regimen with candesartan and hydrochlorothiazide had a greater effect in adults with a less healthy lifestyle than in those with a healthy lifestyle, according to new data from the HOPE-3 study.
The researchers also found that a lipid-lowering regimen with rosuvastatin (Crestor, AstraZeneca) and both regimens combined benefited patients regardless of their lifestyle.
As Cardiology Today previously reported, the HOPE-3 study evaluated 12,521 participants at intermediate risk for CVD who were assigned to candesartan/hydrochlorothiadize plus placebo, rosuvastatin plus placebo, candesartan/hydrochlorothiadize plus rosuvastatin or double placebo.
For the present analysis, participants were stratified by how many of four healthy lifestyle factors they possessed: not smoking, being physically active, having an optimal body weight and following a healthy diet.
Gilles R. Dagenais, MD, from the Quebec Heart and Lung University Institute, Laval University, Quebec City, and colleagues determined whether lifestyle factors influenced the rate of CVD events in each of the groups stratified by BP-lowering and lipid-lowering therapy.
In the overall cohort, participants with at least two healthy lifestyle factors had lower rates of CVD compared with those with one or none (HR = 0.85; 95% CI, 0.73-1), according to the researchers.
Compared with placebo, rosuvastatin reduced CVD risk in participants with at least two healthy lifestyle factors (HR = 0.74; 95% CI, 0.62-0.9) and was associated with a trend toward reduced CVD risk in those with fewer than two health lifestyle factors (HR = 0.79; 95% CI, 0.61-1.01), Dagenais and colleagues wrote.
Participants assigned both candesartan/hydrochlorothiadize and rosuvastatin had lower risk for CVD regardless of lifestyle (HR ≥ 2 healthy lifestyle factors = 0.74; 95% CI, 0.57-0.97; HR < 2 healthy lifestyle factors = 0.61; 95% CI, 0.43-0.88), according to the researchers.
However, those assigned only candesartan/hydrochlorothiadize had reduced CVD risk only if they had fewer than two healthy lifestyle factors (HR = 0.78; 95% CI, 0.61-1).
“Rosuvastatin alone and combined with candesartan/hydrochlorothiazide is beneficial regardless of the health-related lifestyle status; however, the benefit of antihypertensive treatment, although nonsignificant, appears limited to participants with less healthy lifestyle profiles who were at greater risk than those with more healthy factors,” Dagenais and colleagues wrote. “This latter observation requires independent confirmation. These findings have implications for therapeutic decision-making in the primary prevention of CVD. Healthy lifestyle approaches should be improved and integrated with pharmacologic strategies for the primary prevention of CVD and the prevention of other major chronic diseases such as diabetes mellitus and cancers.” – by Erik Swain
Disclosures: HOPE-3 was funded in part by AstraZeneca. Dagenais reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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