ASCOT BPLA trial (atenolol vs amlodipine)

Introduction

Industry funded, randomized, multicenter European trial. Blood-pressure lowering arm of ASCOT clinical trial.

Design:

• 19,257 patients, mean age, 63; 77% men
• hypertension & at least 3 other cardiovascular risk factors
• baseline systolic BP > 160 mm Hg or diastolic BP > 100 mm Hg, or treated systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg

Patients received:

1 - amlodipine 5-10 mg with perindopril 4-8 mg added as needed

2 - atenolol 50-100 mg with bendroflumethiazide 1.25-2.5 mg added as needed # - tertiary therapy added to groups 1 or 2 if necessary

Mean baseline BP was 164/95 mm Hg in both groups

Target BP: <140/90 mm Hg for diabetic patients & <130/80 mm Hg for nondiabetic patients

Results:

• trial stopped early (median follow-up, 5.5 years) because the all-cause mortality rate was significantly lower in amlodipine group than the atenolol group (7.8% vs. 8.9%)
• mean BPs had dropped to 136/77 mm Hg in the amlodipine group & 138/79 mm Hg in the atenolol group, (statistically significant)
• amlodipine group associated with lower rate of stroke, cardiovascular death, new-onset diabetes & non-significant reduction in myocardial infarction
• disconutation of therapy less in amlodipine group than atenolol group (2% vs 3%)
• only 32% of subjects with diabetes & 60% of those without diabetes had reached BP goals by the time the trial was stopped

More general terms

• ASCOT clinical trial
• hypertension clinical trials