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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For a given reduction in blood pressure, some suggested that newer agents would confer advantages over diuretics and beta blockers.

ASCOT-BPLA – Wiki Journal Club

Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. Some purists may be critical of the trial on two points, firstly that the Atenolol comparator 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 analysis was not defined at the start of the study.

The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. 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.

Do Not Change This: The study was stopped prematurely after 5. If these limitations in the study are accepted does it add anything new axcot the body of evidence in Hypertension? 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? And we already know about the diabetes risk posed by the combination of Beta-blockers and Npla.

Our aim, vpla, was to compare the effect on non-fatal myocardial infarction and fatal CHD of combinations of atenolol with a thiazide versus amlodipine with perindopril.


This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide. 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. This page was last modified on 15 Septemberat Accept No thanks Read more.

The main objective of hypertension treatment is to attain and maintain goal BP. Republished in Curr Hypertens Rep.

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.

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.

The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. Leave a Comment Click here to cancel reply. It was hypothesized that adverse side effects of older antihypertensive agents, such as beta-blockers and diuretics, was partially offsetting blla benefit of blood pressure reduction [1].

The trial was stopped prematurely due to a large difference in all-cause mortality between the two treatment groups. There was no statistical difference between the two arms of the study in this endpoint. The same advice has already been given in a previous article on this [ For example there was less peripheral arterial disease and development of diabetes in the Amlodipine and Perindopril b;la.


However, the size asckt benefit was significantly less than predicted compared to previous observational studies aacot. Expert Opinion — Grade E. JavaScript is required for form validation, if you want to use this form please turn JavaScript on or use a different browser.

Bpls process is likely to take six months. Navigation menu Personal tools Create account Log in. Articles in the Lancet and BMJ that have already been covered on this website have also raised this discrepancy and it has [ Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents.


Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD. 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.

Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to ascoh cardiovascular moribidity and mortality. For more detail, read on.

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.

Where there was a statistical difference in the secondary outcomes, perhaps it would have been expected. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Views Read View source View wscot. We use cookies including some third party cookies to ensure that we give you the best experience on our website.

Analysis was by intention to treat.

This was perhaps seen as necessary because there was a difference in the blood pressures of the two arms of 2. The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0. 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.