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 is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide.

The trial was stopped prematurely due to a large difference in all-cause mortality between the two treatment groups. 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? Leave a Comment Click here to cancel reply. Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents.


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 same advice has already been given in a previous article on this [ Views Read View source View history. For example there was less peripheral arterial disease and development of diabetes in the Amlodipine and Perindopril arm. If these limitations in the study are accepted does it sacot anything new to the body of evidence in Hypertension?


ASCOT-BPLA – Wiki Journal Club

Articles in the Lancet and BMJ that have already been covered on this website have also raised this discrepancy and it has [ Analysis was by intention to treat. Secondary outcomes suggest a possible reduction in cardiovascular morbidity and asclt using amlodipine and perindopril, although this may be ascribed to differences in blood pressure between the two study arms. 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.

This page was last modified on 15 Septemberat 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.

Accept No thanks Read more. Though not significant, compared with the atenolol-based regimen, fewer individuals on asoct amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0. 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.

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].

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.

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 main objective of hypertension treatment is to attain and maintain goal BP. The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm.


Leave This Blank Too: Navigation menu Personal tools Create account Log in. Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality. This was perhaps seen as necessary because there was a difference in the blood pressures of the two arms of 2.

If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Where there was a statistical difference in the secondary outcomes, perhaps it would have been adcot. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD.

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.

The clinician should continue to assess BP and adjust the treatment regimen until goal Bppa is reached. For more detail, read on.