“Newer” antihypertensives reduce CV events
Stroke reduced by 23 per cent with an amlodipine-based regimen |
Hypertension specialists are predicting that blood pressure guidelines will change with this week's publication of the final results from ASCOT-BPLA (The Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm) in The
Lancet (2005;366:895).
The results confirm preliminary
data (PJ, 12 March, p291) that antihypertensive
therapy based on the calcium channel blocker amlodipine reduced cardiovascular
events compared with beta-blocker based treatment.
The trial randomised 19,257 hypertensive patients aged 40–79 years
with at least three other cardiovascular risk factors to amlodipine (5–10mg)
with or without perindopril (4–8mg), or atenolol (50–100mg)
with or without bendroflumethiazide (1.25–2.5mg). Target blood
pressure was <140/90mmHg.
Patients given amlodipine-based therapy showed a 10 per cent reduction
in non-fatal myocardial infarction or fatal coronary heart disease compared
with those given atenolol-based treatment (429 versus 474; unadjusted
hazard ratio 0·90, 95 per cent confidence interval 0·79–1·02, P=0.1052). The investigators suggested that the figures did not reach
statistical significance because the study was stopped early when the
safety committee
observed an advantage with amlodipine.
Further results showed patients treated with the amlodipine-based regimen
had a 23 per cent lower rate of fatal and non-fatal stroke, a 16 per
cent reduction in total cardiovascular events and procedures and an 11
per cent lower all-cause mortality. The incidence of developing diabetes
was 30 per cent lower on the amlodipine-based regimen and new-onset renal
dysfunction was reduced by 15 per cent (P=0.02).
One of the study authors, Neil Poulter, professor of preventive cardiovascular
medicine, Imperial College London, and president of the British Hypertension
Society, commented: “Beta-blockers will no longer be the first
choice for uncomplicated hypertension. I think ACE inhibitors will probably
be recommended first line for younger patients, and calcium channel blockers
or diuretics for older patients.”
He pointed out that members of the British Hypertension Society are meeting
representatives of the National Institute for Health and Clinical Excellence
later this month with the hope that together they will develop a shared
set of guidelines for the UK.
The data were presented at the European
Society of Cardiology annual
congress in Stockholm this week. |
The
Pharmaceutical Journal
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