The Anglo-Scandinavian Cardiac Outcomes Trial: blood pressure-lowering limb: effects in patients with type II diabetes.

Abstract

OBJECTIVE:

To compare the effects of two antihypertensive treatment strategies for the prevention of coronary heart disease and other cardiovascular events in the large subpopulation (n=5137) with diabetes mellitus in the blood pressure-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial.

METHODS:

Patients had either untreated hypertension or treated hypertension. For those with type II diabetes mellitus, inclusion criteria required at least two additional risk factors. Patients were randomized to amlodipine with addition of perindopril as required (amlodipine-based) or atenolol with addition of thiazide as required (atenolol-based). Therapy was titrated to achieve a target blood pressure of less than 130/80 mmHg.

RESULTS:

The trial was terminated early due to significant benefits on mortality and stroke associated with the amlodipine-based regimen. In patients with diabetes mellitus, the amlodipine-based treatment reduced the incidence of the composite endpoint--total cardiovascular events and procedures--compared with the atenolol-based regimen (hazard ratio 0.86, confidence interval 0.76-0.98, P=0.026). Fatal and nonfatal strokes were reduced by 25% (P=0.017), peripheral arterial disease by 48% (P=0.004) and noncoronary revascularization procedures by 57% (P<0.001). For the other endpoints included in the composite, the endpoint differences were less clear including coronary heart disease deaths and nonfatal myocardial infarctions (the primary endpoint), which were reduced nonsignificantly by 8% (hazard ratio 0.92, confidence interval 0.74-1.15).

CONCLUSION:

In the large diabetic subgroup in the blood pressure-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial, the benefits of amlodipine-based treatment, compared with atenolol-based treatment, on the incidence of total cardiovascular events and procedures was significant (14% reduction) and similar to that observed in the total trial population (16% reduction).

• Authors: Jan Ostergren, Neil R Poulter, Peter S Sever, Björn Dahlöf, Hans Wedel, Gareth Beevers, Mark Caulfield, Rory Collins, Sverre E Kjeldsen, Arni Kristinsson, Gordon T McInnes, Jesper Mehlsen, Markku Nieminen, Eoin O'Brien, ASCOT investigators
• Journal: Journal of hypertension (J Hypertens) Vol. 26 Issue 11 Pg. 2103-11 (Nov 2008) ISSN: 0263-6352 [Print] England
• PMID: 18854748 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Thiazides
• Amlodipine
• Atenolol
• Perindopril

Topics

• Adult
• Aged
• Amlodipine (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Atenolol (therapeutic use)
• Blood Pressure
• Cardiovascular Diseases (drug therapy, etiology, mortality)
• Diabetes Mellitus, Type 2 (complications, drug therapy)
• Drug Therapy, Combination
• Female
• Humans
• Hypertension (drug therapy, etiology, mortality)
• Male
• Middle Aged
• Perindopril (therapeutic use)
• Peripheral Vascular Diseases (prevention & control)
• Scandinavian and Nordic Countries (epidemiology)
• Stroke (prevention & control)
• Thiazides (therapeutic use)
• United Kingdom (epidemiology)