Role of Blood Pressure and Other Variables in the Differential Cardiovascular Event Rates Noted in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA)

Reasons for therapeutic inertia when managing hypertension in clinical practice in non-Western countries

“…1 Based on randomized control trials the BP control rates can be substantially improved up to 70%. [14][15][16] However, only 53% of hypertensive patients on therapy achieve BP control rates o140/ 90 mm Hg based on the National Health and Nutrition Examination Survey, with little improvement over the last 15 years. 1,4 Many factors contribute to poor BP control, including failure of patients to attend physicians, failure of physicians to detect and adequately treat hypertension to goal levels, and failure of patients to persist with prescribed therapy.…”

Use of beta-blockers for uncomplicated hypertension in the elderly: a cause for concern

“…3 In the elderly with hypertension, large randomized controlled trials have demonstrated reduced efficacy of beta-blockers to prevent cardiovascular events relative to diuretics, 4 angiotensin receptor blockers 5 and calcium channel blockers. 6 The reduced effectiveness of beta-blockers in the elderly has also been confirmed in meta-analyses of trials conducted predominantly in the elderly. 7,8 In this study, we examine the prevalence of prescribing beta-blockers as initial antihypertensive therapy in elderly Ontarians with uncomplicated hypertension and examine the predictors of beta-blocker prescriptions.…”

Review: Angiotensin-converting enzyme inhibitors and coronary heart disease prevention

“…In addition, there was no temporal link between the size of the BP difference and the differences in CHD and stroke events. 23 Allocation to the amlodipine/perindopril treatment regimen was associated with a higher pulse rate, and beneficial effects on body weight, serum high density lipoprotein-cholesterol (HDL-c), creatinine and fasting blood glucose. 15 In particular, differences in HDL-c had the biggest effect on differences in the rates of coronary events.…”

“…15 In particular, differences in HDL-c had the biggest effect on differences in the rates of coronary events. 23 For stroke, multivariate analysis that included biochemical measurements had little or no added benefit after adjustment for BP. These analyses, however, could only account for 40-50% of the variability in CHD and stroke events, which implies that other factors, yet to be identified, may explain a substantial part of the benefit attributable to the amlodipine/perindopril regimen.…”

“…15 Further analysis of ASCOT-BPLA has focused on the possible explanations for the different CV event rates in the two treatment groups. 23 Were the differences in BP sufficient to account for the observed differences in CV outcome? The accumulated mean in-trial difference in systolic blood pressure (SBP) was 2.7 mmHg in favour of the amlodipine-based regimen, but on the basis of observational epidemiology this difference in BP would translate into 8% fewer coronary heart disease (CHD) events and 11% fewer strokes.…”