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The goal of the trial was to assess the safety and efficacy of cholesterol lowering, blood pressure (BP) lowering, or both in patients without known cardiovascular disease (CVD), and with an intermediate risk of major CV events (~1% annually). This has been endorsed by the most recent lipid guidelines, and was also recently observed in the SPRINT trial for BP lowering.

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There was effect modification by baseline SBP, such that patients who truly had hypertension (i.e., 143.5 mm Hg) appeared to benefit with combination treatment.

On the other hand, a fixed-dose combination of candesartan 16 mg HCTZ 12.5 mg daily was not superior to placebo in reducing CV events despite a 6 mm decrease in SBP and a 3 mm decrease in DBP.

6.5%, p = 0.001 Secondary outcomes: : Assessed in patients ≥70 years (available n = 1,626). For the BP arm, it is unclear if the use of other agents such as chlorthalidone or amlodipine would have demonstrated a benefit rather than HCTZ/candesartan. Jackie Bosch at the American Heart Association Annual Scientific Sessions (AHA 2016), New Orleans, LA, November 13, 2016. Yusuf S, Bosch J, Dagenais G, et al., on behalf of the HOPE-3 Investigators. Jackie Bosch at the American College of Cardiology Scientific Session, Chicago, IL, April 2, 2016. Lonn EM, Bosch J, Lopez-Jaramillo P, et al., on behalf of the HOPE-3 Investigators. Blood-Pressure and Cholesterol Lowering in Persons Without Cardiovascular Disease.

This might thus lend itself well to a “polypill” approach for large populations, but lowering of LDL-C and/or BP could have been greater if these were periodically assessed and dosages adjusted accordingly, particularly for the BP lowering arm.

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The results of this trial indicate that the use of low-dose statin therapy with rosuvastatin 10 mg is superior to placebo in reducing long-term CV events in an intermediate-risk population (CV event rate ~1%/year).

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