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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JavaScript is required for form validation, if you want to use this form please turn JavaScript on or use a different browser. Republished in Curr Hypertens Rep.


Do Not Change This: Articles in the Lancet and BMJ that have already been covered on this website have also raised this discrepancy and it has [ 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 outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm. 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 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.

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. For example there was less peripheral arterial disease and development of diabetes in the Amlodipine and Perindopril arm.

This was perhaps seen as necessary because there was a difference in the blood pressures of the two arms of 2.

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


This process is likely to take six months. 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 Ascott could be titrated to mg and the fact that a post-hoc analysis was conducted that shows bplz for the Amlodipine arm but this analysis was not defined at the start of the study.

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. This study was started about 6 years ago and compared the blood pressure awcot effects of Atenolol with Bendroflumethiazide to those of Amlodipine with Perindopril. For more detail, read on. The study was stopped prematurely after 5. There was no statistical difference between the two arms of the study in this endpoint. 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.

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. It was hypothesized that adverse side effects of older antihypertensive agents, such as beta-blockers and diuretics, was partially offsetting the benefit of blood asot reduction [1]. Leave a Comment Click here to cancel reply.

Leave This Blank Too: Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD. Retrieved from ” http: And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics.

ASCOT – BPLA – Prescribing Advice for GPs

At the time, calcium channel blockers Bppa 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. Nevertheless, the results have implications with respect to optimum combinations of ascoh agents. Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide. 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?


Analysis was by intention to treat. 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. If goal BP cannot ascoh reached with 2 drugs, add and titrate a third drug from the list provided.

Accept No thanks Read more. 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. The same advice has already been given in a previous article on this [ This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared asckt Atenolol and Bendroflumethiazide.

Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality. Views Read View source View history. The incidence of developing diabetes was less on the bpls regimen vs ; 0. The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen.

A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge. Expert Opinion — Grade E. Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0. Navigation menu Personal tools Create account Log in.

We did a multicentre, prospective, randomised controlled trial in 19 patients with asco who were aged years and had at least three other cardiovascular risk factors. This blog is bppla by Matthew Robinson. This page was last modified on 15 Septemberat Where there was a statistical difference in the secondary outcomes, perhaps it would have been expected. If these limitations ascto the study are accepted does it add anything new to the body of evidence in Hypertension?