Type your tag names separated by a space and hit enter

Amlodipine adding perindopril versus atenolol adding bendroflumethiazide for hypertension

Evidence Summaries

Level of Evidence = A

An amlodipine-based regimen adding perindopril prevented more major cardiovascular events and induced less diabetes than an atenolol-based regimen adding bendroflumethiazide, although the result was not significant for the primary endpoint (non-fatal myocardial infarction and fatal coronary heart disease (CHD)).

A multicentre, prospective, randomised controlled trial 1 was performed 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). The primary endpoint was non-fatal myocardial infarction (including silent myocardial infarction) and fatal CHD. 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<0.0001), and all-cause mortality (738 vs 820; 0.89, 0.81-0.99, p=0.025). The incidence of developing diabetes was less on the amlodipine-based regimen (567 vs 799; 0.70, 0.63-0.78, p<0.0001). Comment: There was a 2.7 mmHg systolic blood-pressure difference favouring the amlodipine-perindopril group which explains part of the difference in outcomes.

References

1. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J, ASCOT Investigators. 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. Lancet 2005 Sep 10-16;366(9489):895-906.  [PMID:16154016]


Copyright © 2017 Duodecim Medical Publications Limited.
Amlodipine adding perindopril versus atenolol adding bendroflumethiazide for hypertension is a sample topic from the Evidence-Based Medicine Guidelines.

To view other topics, please or purchase a subscription.

Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. Learn more.

Citation

"Amlodipine Adding Perindopril Versus Atenolol Adding Bendroflumethiazide for Hypertension." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/450396/all/Amlodipine_adding_perindopril_versus_atenolol_adding_bendroflumethiazide_for_hypertension.
Amlodipine adding perindopril versus atenolol adding bendroflumethiazide for hypertension. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/450396/all/Amlodipine_adding_perindopril_versus_atenolol_adding_bendroflumethiazide_for_hypertension. Accessed April 24, 2019.
Amlodipine adding perindopril versus atenolol adding bendroflumethiazide for hypertension. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/450396/all/Amlodipine_adding_perindopril_versus_atenolol_adding_bendroflumethiazide_for_hypertension
Amlodipine Adding Perindopril Versus Atenolol Adding Bendroflumethiazide for Hypertension [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2019 April 24]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/450396/all/Amlodipine_adding_perindopril_versus_atenolol_adding_bendroflumethiazide_for_hypertension.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Amlodipine adding perindopril versus atenolol adding bendroflumethiazide for hypertension ID - 450396 BT - Evidence-Based Medicine Guidelines UR - https://evidence.unboundmedicine.com/evidence/view/EBMG/450396/all/Amlodipine_adding_perindopril_versus_atenolol_adding_bendroflumethiazide_for_hypertension PB - Duodecim Medical Publications Limited DB - Evidence Central DP - Unbound Medicine ER -