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 media have already picked up on this new study with the BBC and newspapers like the Telegraph reporting the headline findings of the trial.
The outcomes of the study could be entirely driven by greater reductions in blood pressure that occurred in the Asccot arm. For more detail, read on. 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.
There was no statistical difference between the two arms of the study in this endpoint. Where there was a statistical difference in the secondary outcomes, ascit it would have been expected. For example there was less peripheral bplz disease and development of diabetes in the Amlodipine and Perindopril arm.
This is to be expected due to the peripheral vasodilation effects of Amlodipine zscot Perindopril compared to Atenolol and Bendroflumethiazide. And we already know about the diabetes risk posed by the combination of Beta-blockers and Diuretics. 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 asclt 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.
If these limitations in the study are accepted does it add anything new to the body of evidence in Hypertension? 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.
This was perhaps seen as necessary because there was a difference in the blood pressures of the two arms of 2.
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. This process is likely to take six months.
ASCOT – BPLA – Prescribing Advice for GPs
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