Results of the ASCOT-BPLA trial: no practical implications for treatment of hypertension

(1) An unblinded trial called the ASCOT-BPLA study compared amlodipine (alone or in combination with perindopril) and atenolol (alone or in combination with a thiazide diuretic) in 19 257 hypertensive patients with other cardiovascular risk factors. The patients were followed for about 5.5 years. The doses chosen for this trial were biased in favour of amlodipine, in terms of expected effects on blood pressure, cardiovascular mortality and strokes. However, amlodipine was not associated with a reduction in overall mortality or with a lower frequency of the primary outcome (non fatal myocardial infarction or coronary death). (2) In practice, the best first-line treatment for preventing the cardiovascular morbidity and mortality associated with hypertension remains a diuretic (chlortalidone or hydrochlorothiazide).