This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Anglo-Scandinavian Cardiac Outcomes Trial - Blood Pressure Lowering (ASCOT -BPLA)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • the Anglo-Scandinavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm (ASCOT-BPLA) results were published in September 2005 (1)
    • ASCOT-BPLA was a randomised controlled trial that included 19,257 patients aged 40-79 years with hypertension and with at least three additional risk factors for cardiovascular (CV) disease (e.g. age >55 years, male, smoker, microalbuminuria or proteinuria, type 2 diabetes)
    • patients with prior myocardial infarction (MI), recent stroke, or treated angina were excluded
    • management of hypertension was based on stepped regimens of a beta-blocker (atenolol) and a thiazide diuretic, or a calcium channel blocker (CCB) (amlodipine) and an angiotensin-converting enzyme (ACE) inhibitor, with further addition of doxazosin, if necessary, to achieve blood pressure (BP)
    • on termination of the study 78% of patients were taking at least two drugs
    • ASCOT-BPLA was stopped early by the data safety monitoring board after a median of 5.5 years when interim analysis showed higher mortality for patients in the atenolol group
    • Results (1):
      • primary endpoint (nonfatal MI plus fatal coronary heart disease CHD) - the trial did not reveal a statistical significance between treatment groups:
        • amlodipine group 4.5%; atenolol group 4.9% (HR 0.90; 95% CI 0.79-1.02)
      • there were significant differences in favour of the amlodipine group found in most secondary endpoints including CV mortality, strokes, and CV events plus procedures
      • fewer patients developed new-onset diabetes in the amlodipine group than in the atenolol group: 5.9% vs. 8.3% (HR 0.70; 95% CI 0.63 - 0.78)
      • 25% of patients in both groups stopped therapy early because of adverse events (AEs)
        • fewer did so because of serious AEs in the amlodipine group compared with the atenolol group (1.7% vs. 2.6%, P<0.0001)
  • it has however been stated in a Lancet editorial that the differences in outcomes between groups may be explained by the difference in BP-lowering effects between the two regimens, which averaged 2.7/1.9mmHg during the study (P<0.0001) (2)

Notes:

  • ASCOT-BPLA strengthens the case for a more cautious use of beta-blockers (or at least atenolol) as first-line therapy for hypertension, but there may be occasions when this is appropriate, e.g. a patient has CHD (3)
  • ASCOT-BPLA confirms that a treatment strategy based on a beta-blocker and diuretic can increase the risk of new-onset diabetes
  • ASCOT-BPLA does not diminish the position of thiazide diuretics a highly appropriate first line therapy for many patients with hypertension (4)

Reference:

  1. Dahlöf B et al. for the ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005;366:895?906.
  2. Staessen JA, Birkenhäger WH. Evidence that new antihypertensives are superior to older drugs. Lancet 2005;366:869?70
  3. MeReC Extra (November 2005); 19.
  4. Zarnke KB. Commentary. Evidence Based Medicine 2006;11:42.

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.