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 study was started about 6 years ago and compared the blood pressure lowering effects of Atenolol with Bendroflumethiazide to those of Amlodipine with Perindopril.
Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality. 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 amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen.
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ASCOT – BPLA – Prescribing Advice for GPs
The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm. This blog is maintained by Matthew Robinson. This process is likely to take six months.
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.
Accept No thanks Read more. 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?
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 Where there was a statistical difference in the secondary outcomes, perhaps it would have been expected. 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.
Do Not Change This: Expert Opinion — Grade E. Leave This Blank Too: 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 .
However, the size of benefit was significantly less than predicted compared to previous observational studies . If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. We did a multicentre, prospective, randomised controlled trial in 19 patients with hypertension who were aged years and had at least three other zscot risk factors. And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics.
The main objective of hypertension treatment is to attain and maintain goal BP. 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.
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 [ Amlodipine and perindopril ascoot not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide.
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.
The clinician should continue to assess BP and adjust the treatment regimen until goal BP is xscot. This page was last modified on 15 Septemberat Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents.
A detailed appraisal of the study reveals sacot it doesn’t really add a great deal to our current knowledge. Navigation menu Personal tools Create account Log in.
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.