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
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
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DOI：
10.1016/s0140-6736(05)67185-1
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发表时间：
2005-09-10
期刊：
影响因子：
168.9
通讯作者：
Östergren, J
中科院分区：
文献类型：
--
作者：
Dahlöf, B;Sever, PS;Östergren, J
背景早期高血压试验中注意到的预防冠心病（CHD）的明显不足归因于所使用的利尿剂和β受体阻滞剂的缺点。对于一个给定的降低血压，一些人认为，新的药物将赋予优势利尿剂和P受体阻滞剂。因此，我们的目的是比较非致命性心肌梗死和致命性冠心病的阿替洛尔与噻嗪类药物与培哚普利。方法的组合，我们做了一个多中心，前瞻性，随机对照试验，在19 257例高血压患者年龄在40-79岁，至少有三个其他心血管危险因素。患者被分配为100 -10 mg，根据需要添加培哚普利4-8 mg（基于氨氯地平的方案; n=9639）或阿替洛尔50-100 mg，根据需要添加苄氟噻嗪1.25-2.5 mg和钾（基于阿替洛尔的方案; n=9618）。我们的主要终点是非致死性心肌梗死（包括无症状心肌梗死）和致死性CHD。分析是通过意向治疗结果-研究提前停止后，5.5年的中位数随访，并累计观察106 153患者年。与阿替洛尔为基础的治疗方案相比，氨氯地平为基础的治疗方案的主要终点人数较少，但不显著（429 vs 474;未校正HR 0.90，95% CI 0.79-1.02，p=0.1052），致死性和非致死性卒中（327 vs 422; 0.77，0.66-0.89，p=0.0003），总心血管事件和手术（1362 vs 1602; 0.84，0.78-0.90，p
Background The apparent shortfall in prevention of coronary heart disease (CHD) noted in early hypertension trials has been attributed to disadvantages of the diuretics and beta blockers used. For a given reduction in blood pressure, some suggested that newer agents would confer advantages over diuretics and P blockers. Our aim, therefore, was to compare the effect on non-fatal myocardial infarction and fatal CHD of combinations of atenolol with a thiazide versus amlodipine with perindopril.Methods We did a multicentre, prospective, randomised controlled trial in 19 257 patients with hypertension who were aged 40-79 years and had at least three other cardiovascular risk factors. Patients were assigned either amlodipine 5-10 mg adding perindopril 4-8 mg as required (amlodipine-based regimen; n=9639) or atenolol 50-100 mg adding bendroflumethiazide 1.25-2.5 mg and potassium as required (atenolol-based regimen; n=9618). Our primary endpoint was non-fatal myocardial infarction (including silent myocardial infarction) and fatal CHD. Analysis was by intention to treatFindings The study was stopped prematurely after 5.5 years' median follow-up and accumulated in total 106 153 patient-years of observation. Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint (429 vs 474; unadjusted HR 0.90, 95% CI 0.79-1.02, p=0.1052), fatal and non-fatal stroke (327 vs 422; 0.77, 0.66-0.89, p=0.0003), total cardiovascular events and procedures (1362 vs 1602; 0.84, 0.78-0.90, p