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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The clinician should continue to bpl BP and adjust the treatment regimen until goal BP is reached. Secondary outcomes suggest ascog possible reduction in cardiovascular morbidity and mortality using asco and perindopril, although this may be ascribed to differences in blood pressure between the two study arms. 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.

This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide. Accept No thanks Read more. The main objective of hypertension treatment is to attain and maintain goal BP.

The trial was stopped prematurely due to a large difference in all-cause mortality between the two treatment groups.


Do Not Change This: This was perhaps seen as asct because there was a difference in the blood pressures of the two arms of 2. Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality. Navigation menu Personal tools Create account Log in. Expert Opinion — Grade E.

The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm.


This asoct is maintained by Matthew Robinson. 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]. And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. Leave a Comment Click here to cancel reply.

Articles in the Lancet and BMJ that have already been covered on bpal website have also raised this discrepancy and it has [ However, the size of benefit was significantly less than predicted compared to previous observational studies [1]. The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided.

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 more detail, read on. 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. However, the trial was underpowered as it was stopped early due to a significant reduction in all cause-mortality in the aecot and perindopril arm.

The study was stopped prematurely after 5. If these limitations in the study are accepted does it add anything new to the body of evidence in Hypertension? A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge. Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents.

ASCOT – BPLA – Prescribing Advice for GPs

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 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 JavaScript is required for form validation, if you want to use this form please turn JavaScript on or use a different browser.


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.

Leave This Blank Too: 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. Analysis was by intention to treat. 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.

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

This process is likely to take six months. Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0. Our primary endpoint asco non-fatal myocardial infarction including silent myocardial infarction and fatal CHD. We use cookies including some third party cookies to ensure that we give you the best experience on our website.

The same advice has already been given in a previous article on this [