Cor Vasa 2005, 46(11):437-440
The ASCOT-BPLA study. Treatment based on amlodipine ± perindopril is superior to treatment based on atenolol ± bendroflumethiazide in hypertension control
- Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika
The Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) is a landmark in assessing various types of hypertension control. ASCOT-BPLA involving over 19,000 elderly patients with three and more risk factors compared, in a randomized study, treatment based on the dihydropyridine calcium-channel blocker amlodipine combined with the ACE inhibitor perindopril as needed versus treatment based on atenolol combined with bendroflumethiazide, a diuretic as needed. Amlodipine and atenolol monotherapy was only used at the end of the study by 14.5% and 8.6%
of patients, respectively. At the same time, ASCOT-BPLA demonstrates the importance of, and need for combination hypertension therapy.
ASCOT-BPLA was terminated prematurely because of significant superiority of novel drugs (amlodipine ± perindopril) regard-ing total mortality versus older drugs, atenolol ± bendroflumethiazide. Most patients received combination therapy. Combination therapy including amlodipine + perindopril also significantly reduced cardiovascular mortality by 24%, fatal and non-fatal stroke by 23%, unstable angina by 32% and ischemic peripheral disease by 35%. New-onset diabetes mellitus also occurred significantly less often, by 30%, in patients receiving amlodipine ± perindopril.
Although part of the benefit of amlodipine ± perindopril effect may have been due to the greater decrease in BP in the group, part of the beneficial effect seems to be related to the vasculoprotective and cardioprotective effects of the above drugs.
In elderly hypertensives with three or more cardiovascular risk factors, it may seem appropriate to prefer novel antihypertensives, as may be the case in patients at increased risk of diabetes mellitus, i. e., in patients with increased fasting blood glucose, in patients with impaired glucose tolerance, and in metabolic syndrome patients. The amlodipine and perindopril combination has been shown to be superior to the beta-blocker and diuretic combination.
Keywords: ASCOT-BPLA study; Amlodipine; Perindopril; Hypertension control
Published: November 1, 2005 Show citation