Published in , the Anglo-Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm (ASCOT-BPLA) was conducted to. The latest data from ASCOT came from the blood pressure-lowering arm of the trial (ASCOT-BPLA). Following the presentation of preliminary. Cardiac Outcomes Trial: Blood Pressure-Lowering Arm – ASCOT-BPLA The ASCOT trial revealed the benefit of amlodipine/perindopril for.

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Intensive blood pressure lowering regimens had been shown in multiple randomized acot-bpla trials to reduce cardiovascular moribidity and mortality. 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?

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

Analysis was by intention to treat. Navigation menu Personal tools Create account Log in. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents. Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0.

ASCOT-BPLA – Wiki Journal Club

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. However, the size of benefit was significantly less than predicted compared to previous observational studies [1]. 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 clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. The study was stopped prematurely after 5. The incidence of developing diabetes was less on the amlodipine-based regimen vs ; 0.

The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. 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.

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.

Expert Opinion — Grade E. 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 rtial. Retrieved from ” http: The main objective of hypertension treatment is to attain and maintain goal BP. 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.



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. Republished in Curr Hypertens Rep.

We did a multicentre, prospective, randomised trizl trial in 19 patients with hypertension who were aged years and had at least three other cardiovascular risk factors.

Triql, the trial was underpowered as it was stopped early due to a significant reduction in all cause-mortality in the amlodipine and perindopril arm.

Views Read View source View history. This page was last modified on 15 Septemberat For a given reduction in blood pressure, some suggested that newer agents would confer advantages over diuretics and beta blockers. Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD.

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.