What is the clinical evidence from this study?

Study design: RCT. Population: Hypertension (n=19257). Intervention: Amlodipine ± perindopril vs. Atenolol ± thiazide. Primary outcome: Development of resistant hypertension (HR 0.57, 95% CI 0.50-0.60).

What question did this study set out to answer?

The aim was to identify baseline predictors of resistant hypertension among untreated ASCOT patients and construct a risk score for high-risk individuals.

October 1, 2011Journal of Hypertension

Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT)

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Key result

Randomization to amlodipine ± perindopril versus atenolol ± thiazide significantly reduced the risk of developing resistant hypertension (HR 0.57; 95% CI 0.50-0.60).

Why the study?

What are the baseline predictors of developing resistant hypertension in patients enrolled in the ASCOT trial?

Key Points

The aim was to identify baseline predictors of resistant hypertension among untreated ASCOT patients and construct a risk score for high-risk individuals.
Developed a multivariable Cox model to identify predictors among 3666 previously untreated ASCOT patients.
Conducted secondary analyses on 19,257 randomized patients to evaluate broader trends.
Associated risk factors included baseline systolic blood pressure, diabetes, left ventricular hypertrophy, and other health metrics.
One-third of previously untreated patients and half of all randomized patients developed resistant hypertension during follow-up.
Increasing baseline SBP significantly elevated risk with hazard ratios ranging from 1.24 to 4.43 for higher SBP strata.
Risk score demonstrated a C-statistic of 0.71, indicating effective risk allocation.

Study Design

Type

RCT (n=19,257)

Randomization

Randomized

Multicenter

Yes

Structured PICO

What are the baseline predictors of developing resistant hypertension in patients enrolled in the ASCOT trial?

Population

19,257 randomized patients with hypertension from the ASCOT trial, including 3,666 previously untreated patients, followed for a median of 4.8 to 5.3 years.

Intervention

Predictors of resistant hypertension (including baseline SBP, diabetes, left ventricular hypertrophy, male sex, BMI, fasting glucose, alcohol intake, and randomized therapies like amlodipine ± perindopril or atorvastatin)

Outcome

Development of resistant hypertensionsurrogate

Main Result

Hazard Ratio: 0.57 (95% CI 0.5–0.6)

Baseline systolic blood pressure and the choice of antihypertensive therapy are major determinants of developing resistant hypertension, which can be predicted using a simple risk score.

Discussion

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Implication

Amlodipine-based therapy was associated with lower resistant hypertension risk; leaves open optimal initial regimens across broader populations.

Cite This Study

Gupta et al. (2011) conducted an RCT in Hypertension (n=19,257). Amlodipine ± perindopril vs. Atenolol ± thiazide was evaluated on Development of resistant hypertension (HR 0.57, 95% CI 0.50-0.60). Randomization to amlodipine ± perindopril versus atenolol ± thiazide significantly reduced the risk of developing resistant hypertension (HR 0.57; 95% CI 0.50-0.60).

synapsesocial.com/papers/6a71b6fea7fbea1e44087d38 https://doi.org/10.1097/hjh.0b013e32834a8a42

Topics

Hypertension management

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Implication

Amlodipine-based therapy was associated with lower resistant hypertension risk; leaves open optimal initial regimens across broader populations.

Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT)

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT)

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

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Topics

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