When premature is not premature—the ASCOT studyThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Abstract

‘ Controversy is the Lifeblood of Science ’Sir George Pickering1 Almost 3 years ago, in the aftermath of the ALLHAT study,2 the New York Times was carrying the headlines ‘Older way to treat hypertension found best’.3 ALLHAT, the largest study ever done, showed no difference in primary outcome (coronary heart disease) among the three treatment arms but seemed to favour chlorthalidone over amlodipine or lisinopril with regard to some secondary endpoints. Clearly, these headlines will need to be amended in view of the recent premature termination of the ASCOT trial.4 The primary objective of ASCOT was to compare the effects on fatal and non-fatal coronary heart disease of a so-called ‘conventional’ treatment, i.e. a beta-blocker (atenolol), combined, if needed, with a thiazide diuretic, to a more contemporary regimen of a calcium antagonist (amlodipine) and, if needed, an ACE-inhibitor (perindopril). In a prospective randomized open-blinded endpoint design (PROBE), a total of 19 000 patients were randomized to the two antihypertensive strategies. The study was launched in 1997 and stopped about 1 year …