Cardiac Drugs Trial Could Save Pounds - And Lives

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Sussex is at the heart of a massive international research project to investigate the treatment of high blood pressure. Called the Anglo Scandinavian Cardiac Outcomes Trial (ASCOT), it will take place over a seven year period. It is one of the largest-scale cardiac drug trials ever, involving eight countries, hundreds of researchers, and 18,000 subjects.

The trial will be investigating differences between conventional and contemporary forms of treatment for high blood pressure. Traditionally hypertension has been treated by a combination of betablockers and diuretics, but new forms of treatment have become more popular over the last few years. There has never been a comparative study of these drugs before - firm evidence that drug treatment saves lives only exists for the older drugs. The ASCOT trial will be able to fundamentally determine which course of action is the most effective at preventing heart disease, strokes and kidney problems.

Dr Andrew Polmear is co-ordinating the Sussex branch of the research project. Andrew, who is based in the Trafford Centre, believes that a trial is long overdue: "Although both sets of drugs seem to lower blood pressure equally effectively, we don't know if one sort is better than the other at preventing the conditions that we are actually treating the high blood pressure for. Put simply, we want to see if there are more people having heart attacks in one group than in the other." "Contemporary treatment for hypertension is hugely more expensive than conventional treatment. These new drugs are being heavily promoted by drug companies, and in theory they might be better. But human beings never react the way you would predict from theory. Since no-one really knows whether they are more effective, the Health Service could be spending a lot of money unnecessarily."

Some patients have distinct medical reasons why they need to be prescribed the new drugs - for example, people with asthma can't take betablockers. Only patients who are eligible for both courses of treatment can be admitted to the trial. A centralised computer, responsible for co-ordinating the UK arm of the trial, will randomly select which treatment each patient will be given.

Every patient on the trial must have high blood pressure which is not being controlled to a perfect level, or which they are not currently being treated for. They must be between 40 and 79, and they must have at least three risk factors for heart disease; for instance, they could smoke, be over 55 and have a high cholesterol ratio. There has to be some chance of them having cardiac problems or other related conditions over the next seven years. Recruiting 18, 000 people who fit this bill is a stiff challenge - Andrew has found it "incredibly difficult". However, the Sussex study is on track to reach its target.

Andrew admits that "If there is a variation in the two arms of our trial, it's not going to be a big one. But with such a large study, we will truly be able to say that if there was a difference, we'd have found it. If there is a difference, we might be able to save thousands of lives. And if there isn't, if betablockers are just as effective as the contemporary drugs, we could save millions of pounds. That's money that could be well spent elsewhere."

High blood pressure affects 10 per cent of the population