ASCOT-BLPA

An antihypertensive regimen of amlodipine with added perindopril significantly reduces all-cause mortality and most major adverse cardiovascular outcomes compared with a regimen of atenolol with the addition of a diuretic, according to the final results of ASCOT-BPLA (Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm). The results from ASCOT-BPLA were presented at the European Society of Cardiology Congress 2005 in Stockholm, Sweden.

The ASCOT-BPLA included 19,257 patients with hypertension who had at least 3 other cardiovascular risk factors. Patients were randomized to either 5 to 10 mg of amlodipine with 4 to 8 mg of perindopril as required or 50 to 100 mg of atenolol with the addition of 1.25 to 2.5 mg of bendroflumethiazide and potassium as required.

The primary end point was nonfatal MI and fatal coronary heart disease (CHD).

The amlodipine/perindopril strategy conferred an advantage in all prespecified subgroups, said Neil R. Poulter, MD, co-investigator of ASCOT and professor of preventive cardiology medicine, Imperial College London.

There was a mean blood pressure difference of 2.7/1.9 mmHg throughout the trial in favor of the amlodipine/ perindopril regimen. "Blood pressure differences are unlikely to be a single explanation," said Dr Poulter. "Blood pressure accounted for about 15% of the coronary differences and 30% of the stroke differences."

When using a technique called serial mean matching, which includes only those patients with similar systolic blood pressures during the trial, the incidences of coronary events and strokes were still less with the amlodipine/ perindopril strategy, he said.

"Given the large population burden of hypertension, even modest incremental benefits of specific agents over others can translate into an important public-health impact," said Salim Yusuf, DPhil, professor of medicine and director, division of cardiology, McMaster University, Ontario, Canada.