ASCOT-BPLA TRIAL PDF

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

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The goal of the blood pressure lowering arm of the trial was to evaluate whether treatment with a newer antihypertensive regimen of calcium channel blocker with or without an angiotensin-converting enzyme ACE inhibitor is more effective than an older regimen of beta-blocker with or without a diuretic, and whether it reduces coronary heart disease CHD events in hypertensive patients with relatively low cholesterol levels.

Patients Enrolled: 19, Mean Follow Up: 5. At 16 years of follow-up: Incidence rate of all-cause mortality was 2. Incidence rate of stroke was 0. Prespecified subgroups showed similar efficacy. There were no differences in serious adverse events by treatment strategy.

Baseline CRP only minimally added to risk prediction and it did not indicate the magnitude of response to atorvastatin therapy. Among patients with hypertension and relatively low cholesterol, a strategy of treatment with amlodipine and perindopril if needed was associated with reductions in many secondary endpoints, including mortality, compared with treatment with the beta-blocker atenolol and the diuretic bendroflumethiazide, prompting the trial to be discontinued early in order to substitute appropriate alternative antihypertensive therapy in the beta-blocker group.

At 16 years of follow-up, the amlodipine-based group was associated with a small, but significantly significant reduction in stroke. The ALLHAT trial had a similar design, with hypertensive patients randomized to antihypertensive therapy, and a subgroup of patients with mild hypercholesterolemia randomized to pravastatin versus usual care.

However, for certain secondary outcomes, such as chronic heart failure, rates were lower among patients treated with chlorthalidone versus lisinopril or amlodipine. There is little role for CRP in predicting risk or in making clinical decisions regarding statin therapy. Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial ASCOT Legacy study: year follow-up results of a randomized factorial trial.

Lancet ;Aug [Epub ahead of print]. Presented by Dr. Lancet ; Description: The goal of the blood pressure lowering arm of the trial was to evaluate whether treatment with a newer antihypertensive regimen of calcium channel blocker with or without an angiotensin-converting enzyme ACE inhibitor is more effective than an older regimen of beta-blocker with or without a diuretic, and whether it reduces coronary heart disease CHD events in hypertensive patients with relatively low cholesterol levels.

Interpretation: Among patients with hypertension and relatively low cholesterol, a strategy of treatment with amlodipine and perindopril if needed was associated with reductions in many secondary endpoints, including mortality, compared with treatment with the beta-blocker atenolol and the diuretic bendroflumethiazide, prompting the trial to be discontinued early in order to substitute appropriate alternative antihypertensive therapy in the beta-blocker group.

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ASCOT-BPLA

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? Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. 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. 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. Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality.

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