Key result
The amlodipine and perindopril combination demonstrated a long-term protective effect, reducing mortality by 21% and stroke by 29% during a 20-year follow-up in the ASCOT-Legacy trial.
Why the study?
To provide an overview of the evolution of hypertension identification and treatment in the 15 years following the publication of the ASCOT trial results.
Does combined antihypertensive therapy with amlodipine and perindopril reduce cardiovascular events in hypertensive patients compared to atenolol and bendroflumethiazide?
Does combined antihypertensive therapy with amlodipine and perindopril reduce cardiovascular events in hypertensive patients compared to atenolol and bendroflumethiazide?
The review reinforces current guidelines recommending early initiation of fixed-dose combination therapy (such as amlodipine/perindopril) for hypertension to achieve long-term cardiovascular benefits and improve adherence.
Answers are grounded in this paper and cite their sources.
Supports amlodipine/perindopril preference in hypertension; extends ASCOT by implicating central BP and variability as key targets.
The paper presents the overview evolution of hypertension identification and treatment during last 15 years after publication of ASCOT trial (AngloScandinavian Cardiac Outcomes Trial) results. It discusses possible mechanism of more significant cardiovascular risk reduction in amlodipine/ perindopril group comparing with atenolol/diuretic group: central blood pressure, arterial stiffness, asleep blood pressure and BP variability. Innovative approaches in time of ASCOТ trial such as combined antihypertensive therapy from start and RAAS inhibitor as first line now became routine practice in actual guidelines. Importance of early prescribing of fixed antihypertensive combination and choice of safe drugs help to improve adherence and decrease resistant hypertension prevalence. Prevention of new onset of diabetes in metabolic patients needs application of metabolically neutral drugs and including of renin-angiotensin-aldosterone inhibitors in combination therapy. Results of ASCOT-Legacy trial demonstrated long-term protective effect of amlodipine/perindopril combination resulting in decreasing mortality, rate of stroke and coronary events during 20-years follow-up.
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О. P. Rotar (2021) conducted a review in Hypertension (n=19,257). Amlodipine and perindopril combination vs. Atenolol and bendroflumethiazide combination was evaluated on Mortality (ASCOT-Legacy) (21% reduction). The amlodipine and perindopril combination demonstrated a long-term protective effect, reducing mortality by 21% and stroke by 29% during a 20-year follow-up in the ASCOT-Legacy trial.
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