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ASCOT-BPLA signals changes to hypertension guidelines.

The Anglo-Scandanavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm (ASCOT-BPLA) was a multi-centre, prospective, randomised, controlled trial in 19 257 patients with hypertension, aged 40-79 years, with at least three other cardiovascular (CVS) risk factors. Patients were assigned to either arnlodipine (5-10 mg), adding perindopril (4-8 mg) as required (arnlodipine-based regimen, n = 9 639), or atenolol (50-100 mg), adding bendroflumethiazide (1.25-2.5 mg) and potassium as required (atenolol-based regimen, n = 9 618). The primary end-point was non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD). Although there was a non-significant 10% reduction in the primary end-point in favour of the arnlodipine-based regimen, the study was prematurely stopped after a median follow up of 5.5 years by the Data and Safety Monitoring Committee, because of clinically important reductions in secondary end-points (Table I).