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

This process is likely to take six months. 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.

Republished in Curr Hypertens Rep.

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? There was no statistical difference between the two arms of the study in this endpoint.

ASCOT – BPLA – Prescribing Advice for GPs

The study was stopped prematurely after 5. 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.

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

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


Accept No thanks Read more. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide.

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Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0. For more detail, read on. Where there was a statistical difference in the secondary outcomes, perhaps it would have been expected.

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.

Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality.

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

However, the size of benefit was significantly less than predicted compared to previous observational studies [1]. The main objective of hypertension treatment is to attain and maintain goal BP. 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. A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge.


If these limitations in the study are accepted does it add anything new to the body of evidence in Hypertension? This page was last modified on 15 Septemberat Leave This Blank Too: Articles in the Lancet and BMJ that have already been covered on this website have also raised this discrepancy and it has [ Retrieved from ” http: Leave a Comment Click here to cancel reply.

This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide. This was perhaps seen as necessary because there was a difference in the blood pressures of the two arms of 2. 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.

For example there was less peripheral arterial disease and development of diabetes in the Amlodipine and Perindopril arm. Navigation menu Personal tools Create account Log in.

ASCOT-BPLA – Wiki Journal Club

Views Read View source View history. 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.

Expert Opinion — Grade E. Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents. Do Not Change This: And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics. The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen.

The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0. Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD.