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

The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0. This was perhaps seen as necessary because there was a difference in the blood pressures of the two arms of 2. Aascot This Blank Too: This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide. Retrieved from ” http: Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality.

Analysis was by intention to treat.


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

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 asdot after the ascog. Leave a Comment Click here to cancel reply.

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A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge. At the time, calcium channel blockers CCBs and ACE inhibitors ACEIs were novel asot agents hypothesized to have less adverse metabolic effects and provide additional cardiovascular protection beyond its blood pressure effects.

ASCOT-BPLA – Wiki Journal Club

The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. The study was stopped prematurely after 5. 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 example there was less peripheral arterial disease and development of diabetes in the Amlodipine and Perindopril arm.

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. 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.

ASCOT – BPLA – Prescribing Advice for GPs

We use cookies including some third party cookies to ensure that we give you the best experience on our website. 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 dose 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.

Republished in Curr Hypertens Rep. If these limitations in the study are accepted does it add anything new to the body of evidence in Hypertension? This blog is maintained by Matthew Robinson.


If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. 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.

Do Not Change This: This process is likely to take six months. 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. 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.

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.

For a given reduction in blood pressure, some suggested that newer agents would confer advantages over diuretics and beta blockers. There was no statistical difference between the two arms of the study in this endpoint.

Where there was a statistical difference in the secondary outcomes, perhaps it would npla been expected. 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.

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