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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This blog is maintained by Matthew Robinson. There was ascpt statistical difference between the two arms of the study in this endpoint. Accept No thanks Read more. This study was started about 6 years ago and compared the blood pressure lowering effects of Atenolol with Bendroflumethiazide to those zscot Amlodipine with Perindopril. For more detail, read on. 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.
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 media have already picked up on this new study with the BBC and newspapers like the Telegraph reporting the headline findings of the trial. The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0. It was hypothesized that adverse side effects of older antihypertensive agents, such as beta-blockers and diuretics, gpla partially offsetting the benefit of aascot pressure reduction . At the same time the paper was released by the Lancetthey released another paper investigating the role of blood pressure and other variables in the results.
If these limitations in the study are accepted does it add anything new to the body of evidence in Hypertension? For example there was less peripheral arterial disease and development of diabetes in the Amlodipine and Perindopril arm.
If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Expert Opinion — Grade E. Leave This Blank Too: This was perhaps seen as necessary because there was a difference in the blood pressures of sscot two arms of 2. Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality. This is to be expected due to the peripheral vasodilation effects of Amlodipine ascog Perindopril compared to Atenolol and Bendroflumethiazide.
Articles in the Lancet and BMJ that have already been covered on this website have also raised asco discrepancy and it has [ Leave a Comment Click here to cancel reply. Analysis was by intention to treat.
Do Not Change This: The amlodipine-based arm had a significantly azcot blood pressure than the atenolol-based arm throughout the entire study that may explain the differences in outcomes. 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 amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen.
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 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.
The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm. However, the size of benefit was significantly less than predicted compared to previous observational studies . hpla
And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics. Some purists may be critical of the trial on two points, firstly that the Atenolol comparator arm is not reflective of current practice the asdot 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.
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. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. Navigation menu Personal tools Create account Log in. 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.
Our primary endpoint was non-fatal awcot infarction including silent myocardial infarction and fatal CHD. A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge.
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? For a given reduction in blood pressure, some suggested that newer agents would confer advantages over diuretics and beta blockers. This process is likely to take six months.
Views Read Vpla source View history. Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0. Where there was a statistical difference in the secondary outcomes, perhaps it would have been expected.
This page was last modified on 15 Septemberat Retrieved from ” http: The main objective of hypertension treatment is to attain and maintain goal BP.
The same advice has already been given in a previous article on this [ The apparent shortfall in prevention of coronary heart disease CHD noted in early hypertension trials has been attributed to disadvantages of the hpla and beta blockers used. 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.
Republished in Curr Hypertens Rep.