Björn Dahlöf， Peter S Sever， Neil R Poulter， Hans Wedel， D Gareth Beevers， Mark Caulfield， Rory Collins， Sverre E Kjeldsen， Arni Kristinsson，Gordon T McInnes， Jesper Mehlsen， Markku Nieminen， Eoin O´Brien， Jan Östergren， for the ASCOT investigators* Summary
Background ：The apparent shortfall in prevention of coronary heart disease (CHD) noted in early hypertension trials has been attributed to disadvantages of the diuretics and β blockers used. For a given reduction in blood pressure， some suggested that newer agents would confer advantages over diuretics and βblockers. Our aim， therefore， was to compare the effect on non-fatal myocardial infarction and fatal CHD of combinations of atenolol with a thiazide versus amlodipine with perindopril. Methods： We did a multicentre， prospective， randomised controlled trial 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). Our primary endpoint was non-fatal myocardial infarction (including silent myocardial infaction) and fatal CHD. Analysis was by intention to treat. Findings 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). Interpretation The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. On the basis of previous trial evidence， these effects might not be entirely explained by better control of blood pressure， and this issue is addressed in the accompanying article. Nevertheless， the results have implications with respect to optimum combinations of antihypertensive agents. 相关幻灯： ASCOT-LLA研究 ASCOT-BPLA COMPANION & CARE-HF CIBIS III PREAMI CLARITY STEEPLE BASKET 相关文章： [ESC2005最新报道]：ASCOT－BPLA研究结果 2005年Lancet公布ASCOT-BPLA试验结果全文(PDF下载) [ESC2005最新报道]：新的抗血栓药用于急性冠脉综合征事件后有效 [ESC2005最新报道]：CIBIS III研究：β受体阻滞剂作为心力衰竭的初始治疗药物有效 [ESC2005最新报道]：PCI-CLARITY研究：PCI前应用氯比格雷有益 [ESC2005最新报道]：BASKET研究：药物涂层支架只对部分患者的费效关系佳 [ESC2005最新报道]：应用大剂量维生素B可能有心血管危险 [ESC2005最新报道]：PREAMI研究显示培哚普利可预防心肌梗死患者的心脏重构 [ESC2005最新报道]：发现依诺肝素在PCI中的应用有减少出血的益处 [ESC2005最新报道]：ELISA II研究：应用双重或三重抗血小板治疗后心肌梗死面积相似 [ESC2005最新报道]：RITA 3研究支持从长远看ACS患者应常规应用介入治疗 [ESC2005最新报道]：IMAGINE试验：ACE抑制剂对冠脉搭桥术后早期患者无益处 [ESC2005最新报道]：ESSENTIAL试验：晚期收缩性心力衰竭患者口服依诺昔酮没有临床益处 [ESC2005最新报道]：SIRIUS II试验显示乌拉立肽对急性失代偿性心力衰竭患者可能有益 [ESC2005最新报道]：ASSENT IV试验：血管成形术前进行溶栓治疗与死亡率较高相关 [ESC2005最新报道]：SOFA试验：鱼油在心律失常治疗方面没有地位 [ESC2005最新报道]：ISSUE II 试验：应用可植入性环状心律记录仪指导治疗可减少晕厥再发 [ESC2005最新报道]：BNP可能预测大剂量化疗引起的左心室功能障碍 [ESC2005最新报道]：检测新生儿的心电图可预防新生儿猝死综合征 [ESC2005最新报道]：代谢综合征可能是心血管疾病的独立危险因素 [ESC2005最新报道]：冠状动脉“正常”女性的危险更甚于男性