Published in , the Anglo-Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm (ASCOT-BPLA) was conducted to. The latest data from ASCOT came from the blood pressure-lowering arm of the trial (ASCOT-BPLA). Following the presentation of preliminary. Cardiac Outcomes Trial: Blood Pressure-Lowering Arm – ASCOT-BPLA The ASCOT trial revealed the benefit of amlodipine/perindopril for.

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Expert Opinion — Grade E.

Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality. 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. Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD.

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? 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.

The clinician should continue to assess BP and adjust the treatment regimen until goal BP trisl reached. It was hypothesized that adverse side effects of older antihypertensive agents, such as beta-blockers and diuretics, was partially offsetting the benefit of blood pressure reduction [1].


However, the size of benefit was significantly less than predicted compared to previous observational studies [1]. Nevertheless, the results have implications with respect tral optimum combinations of antihypertensive agents.

The study was stopped prematurely after 5. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide.

The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0. The amlodipine-based regimen ascog-bpla more major cardiovascular events and induced less diabetes than the atenolol-based regimen. However, the trial was underpowered as it was stopped early due to a significant reduction in all cause-mortality in the amlodipine and perindopril arm. Views Read View source View history.


On the basis of previous trial evidence, these effects might not be entirely explained by better control of blood pressure, and this issue is addressed in the accompanying article. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Navigation menu Personal tools Create account Log in. This page was last modified on 15 Septemberat Analysis was by intention to treat. 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.

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Republished in Curr Hypertens Rep.

ASCOT-BPLA – Wiki Journal Club

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.

The trial was stopped prematurely due to a large difference in all-cause mortality between the two treatment groups. Retrieved from ” http: The apparent shortfall in prevention of coronary heart disease CHD noted in early hypertension trials triao been attributed to disadvantages of the diuretics and beta blockers used. 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.

Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0. The main objective of hypertension treatment is to attain and maintain goal BP.

We did a multicentre, prospective, randomised controlled trial in 19 patients with hypertension who were aged years and had at least three other cardiovascular risk factors.