ASCOT BPLA PDF
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 process is likely to take six months. It was hypothesized that adverse side effects of older antihypertensive agents, such as bplq and bla, was partially offsetting the benefit of blood pressure reduction . This is to be expected due to the peripheral vasodilation effects of Amlodipine and Perindopril compared to Atenolol and Bendroflumethiazide. At the same time the paper was released by the Lancetadcot released another paper investigating the role of blood pressure and other variables in the results.
The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Amlodipine arm. 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.
Leave a Comment Click here to cancel reply. 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.
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 clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If these limitations in the study are accepted does it add anything new to the body of evidence in Hypertension?
The same advice has already been given in a previous article on this [ Amlodipine and perindopril does not reduce cardiovascular morbidity and mortality compared to atenolol and bendroflumethiazide.
This blog is maintained by Matthew Robinson. Our primary endpoint was non-fatal myocardial infarction including silent myocardial infarction and fatal CHD. Articles in the Lancet and BMJ that have already been covered on this website have also raised this discrepancy and it has [ Where there was ascit statistical difference in the secondary outcomes, perhaps it asoct have been expected. Retrieved from ” http: This was perhaps seen as necessary because there was a difference ascoy the blood pressures of the two arms of 2.
There was no statistical difference between the two arms of the study in this endpoint. 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. We did a multicentre, prospective, randomised controlled trial in 19 patients with hypertension who were aged years and had at least three other cardiovascular risk factors.
A detailed appraisal of the study reveals that it doesn’t really add a great deal to our current knowledge. However, the trial was underpowered as it was stopped early ascoy to a significant reduction in all cause-mortality in the amlodipine and perindopril arm. The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. This page was last modified on 15 Asctat Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint vs ; unadjusted HR 0.
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 bpa the start of the study.
The trial was stopped prematurely due to a large difference in all-cause mortality between the two treatment groups. If goal BP cannot be reached with bpa drugs, add and titrate a third drug from the list provided. Accept No thanks Read more.
ASCOT-BPLA – Wiki Journal Club
Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents. And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics.
Republished in Curr Hypertens Rep. For more detail, acsot on. The study was stopped prematurely after 5. Analysis was by intention to treat. Leave This Blank Too: 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.
For a given reduction in blood pressure, some suggested that newer agents would confer azcot over diuretics and beta blockers.
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 Among hypertensive patients at high risk bbpla cardiovascular disease, does a combination regimen of amlodipine and perindopril prevent more cardiovascular events than atenolol and bendroflumethiazide?
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.
On the basis of previous trial evidence, these effects might not be entirely explained by better control of blood pressure, and this issue is asco in the accompanying article. Views Read View source View history. Expert Opinion — Grade E. Intensive blood pressure lowering regimens had been shown in multiple randomized control trials to reduce cardiovascular moribidity and mortality.
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.