Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding. ASCOT-BPLA is one of the first major studies to compare combination antihypertensive regimens. Although the trial design started patients with. ASCOT-BPLA Trial Overview. ♢ a multi-center randomized placebo-controlled trial to determine effects of amlodipine +/- perindopril vs atenolol.
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And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics. We did a multicentre, prospective, randomised controlled trial in 19 patients with hypertension who were aged years and had at least three ascoot cardiovascular risk factors. The trial was stopped prematurely due to a large difference in all-cause mortality between the two treatment groups.
At the time, calcium channel blockers CCBs and ACE inhibitors ACEIs were novel antihypertensive agents hypothesized to have less adverse metabolic effects and provide additional cardiovascular protection beyond its blood pressure effects. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. The lack of statistical significance may have been due to early trial termination, as the trial did not meet the pre-specified number of primary events of For a given reduction in blood pressure, some suggested that newer agents would confer advantages over diuretics and beta blockers.
The same advice has already been given in a previous article on this [ If these limitations in the study are accepted does it add anything new to the body of evidence in Hypertension? This blog is maintained by Matthew Robinson. Expert Opinion — Grade E. Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents.
Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality. The amlodipine-based arm had a significantly lower blood pressure than the atenolol-based arm throughout the entire study that may explain the differences in outcomes. For more detail, read on. This process is likely to take six months. The apparent shortfall in prevention of coronary heart disease CHD noted in early hypertension trials has been attributed to disadvantages of the diuretics and beta blockers used.
Analysis was by intention to treat.
Secondary outcomes suggest a possible reduction in cardiovascular morbidity and mortality using amlodipine and perindopril, although this may be ascribed to differences in blood pressure between the two study arms. Overall, this investigation found that correcting for these variables reduced the differences by about half for coronary events and by just under half for stroke events, and that neither were statistically significant after the correction.
The study was stopped prematurely after 5. This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide. Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and bpoa CHD.
Some purists may be critical of the trial on two points, firstly that the Atenolol asot arm is not reflective of current practice the dose of Atenolol could be titrated to mg and the fact that a post-hoc analysis was conducted that shows benefit for the Amlodipine arm but this asct was not defined at the start of the study. Where there was a statistical difference in the secondary outcomes, perhaps it would have been expected.
This study was started about 6 years ago and compared the blood pressure lowering effects of Atenolol with Bendroflumethiazide to those of Amlodipine with Perindopril. The media have already picked up on this new study with the BBC and newspapers like the Telegraph reporting the headline findings of the trial.
A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge. Leave This Blank Too: Navigation menu Personal tools Create account Log in.
ASCOT-BPLA – Wiki Journal Club
Our aim, therefore, was to compare the effect on non-fatal myocardial infarction and fatal CHD of combinations of atenolol with a thiazide versus amlodipine with perindopril. Leave a Comment Click here to cancel reply. This page was last modified on 15 Septemberat However, the size of benefit was significantly less than predicted compared to previous observational studies .
Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. Republished in Curr Hypertens Rep. Among hypertensive patients at high risk of cardiovascular disease, does a combination regimen of amlodipine and perindopril prevent more cardiovascular events than atenolol and bendroflumethiazide?
The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0. Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0.
However, the trial was underpowered awcot it was stopped early due to a significant reduction in all cause-mortality in the amlodipine and perindopril arm.
The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm. Retrieved from ” http: At the same asccot the paper was aacot by the Lancetthey released another paper investigating the role of blood pressure and other variables in the results. There was no statistical difference between the two arms of the study in this endpoint.