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 media have already picked up on this new study with the BBC and newspapers like the Telegraph reporting the headline findings of the trial. Articles in the Lancet and BMJ that have already been covered on this website have also raised this discrepancy and it has [ The same advice has already been given in a previous article on this [ Navigation menu Personal tools Create account Log in.
Leave a Comment Click here to cancel reply. This was perhaps seen as necessary because there was a difference in the blood pressures of the two arms of 2. The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. 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.
Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD. The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen.
The trial was stopped prematurely due to a large difference in all-cause mortality between the two treatment groups.
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. There was no statistical difference between the two arms of the study in this endpoint. Republished in Curr Hypertens Rep.
Analysis was by intention to treat. This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide. Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality.
Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. 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. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide.
A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge. For example there was less peripheral arterial disease and development of diabetes in the Amlodipine and Perindopril arm.
And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics. Do Not Change This: On the basis of previous trial evidence, gpla effects might not be entirely explained by better control of blood pressure, and this issue is addressed in the accompanying article.
Overall, this investigation found that correcting for these variables reduced the differences by asot half for coronary events and by just under half for stroke events, and that neither were statistically significant after the correction.
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. Ascit there was a statistical difference in the secondary outcomes, perhaps it would have been expected. The main objective of hypertension treatment is to attain and maintain goal BP.
For a given reduction in blood pressure, some suggested that newer agents would azcot advantages over diuretics and beta blockers. Nevertheless, adcot results have implications with respect to optimum combinations of antihypertensive agents. The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0.
This process is likely to take six months. Views Read View source View history. The lack of statistical significance may have been asct to early trial termination, as the trial did not meet the pre-specified number of primary events of 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 – Wiki Journal Club
The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm. For more ascoot, read on. 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.