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

https://arctichealth.org/en/permalink/ahliterature154723
Source
J Hypertens. 2008 Nov;26(11):2103-11
Publication Type
Article
Date
Nov-2008
Author
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
Author Affiliation
Department of Medicine, Karolinska University Hospital Solna, Stockholm, Sweden. jan.ostergren@karolinska.se
Source
J Hypertens. 2008 Nov;26(11):2103-11
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
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
Great Britain - epidemiology
Humans
Hypertension - drug therapy - etiology - mortality
Male
Middle Aged
Perindopril - therapeutic use
Peripheral Vascular Diseases - prevention & control
Scandinavia - epidemiology
Stroke - prevention & control
Thiazides - therapeutic use
Abstract
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.
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.
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
Notes
Comment In: Expert Rev Cardiovasc Ther. 2009 Mar;7(3):269-7119296764
PubMed ID
18854748 View in PubMed
Less detail

Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk.

https://arctichealth.org/en/permalink/ahliterature131745
Source
J Hypertens. 2011 Oct;29(10):2004-13
Publication Type
Article
Date
Oct-2011
Author
Ajay K Gupta
Efthimia G Nasothimiou
Choon L Chang
Peter S Sever
Bjorn Dahlöf
Neil R Poulter
Author Affiliation
International Centre for Circulatory Health, Imperial College London, London, UK. A.K.Gupta@imperial.ac.uk
Source
J Hypertens. 2011 Oct;29(10):2004-13
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Aged
Algorithms
Amlodipine - therapeutic use
Antihypertensive Agents - therapeutic use
Atenolol - therapeutic use
Bendroflumethiazide - therapeutic use
Diuretics - therapeutic use
Drug resistance
Female
Great Britain
Humans
Hypertension - drug therapy - physiopathology
Ireland
Male
Middle Aged
Perindopril - therapeutic use
Risk factors
Scandinavia
Abstract
Resistant hypertension is a well recognized clinical entity, which has been inadequately researched to date.
A multivariable Cox model was developed to identify baseline predictors of developing resistant hypertension among 3666 previously untreated Anglo-Scandinavian Cardiac Outcome Trial (ASCOT) patients and construct a risk score to identify those at high risk. Secondary analyses included evaluations among all 19?257 randomized patients.
One-third (1258) of previously untreated, and one-half (9333) of all randomized patients (incidence rates 75.2 and 129.7 per 1000 person-years, respectively) developed resistant hypertension during a median follow-up of 5.3 and 4.8 years, respectively. Increasing strata of baseline SBP (151-160, 161-170, 171-180, and >180?mmHg) were associated with increased risk of developing resistant hypertension [hazard ratio 1.24 (95% confidence interval, CI 0.81-1.88), 1.50 (1.03-2.20), 2.15 (1.47-3.16), and 4.43 (3.04-6.45), respectively]. Diabetes, left ventricular hypertrophy, male sex, and raised BMI, fasting glucose, and alcohol intake were other significant determinants of resistant hypertension. Randomization to amlodipine?±?perindopril vs. atenolol?±?thiazide [0.57 (0.50-0.60)], previous use of aspirin [0.78 (0.62-0.98)], and randomization to atorvastatin vs. placebo [0.87 (0.76-1.00)] significantly reduced the risk of resistant hypertension. Secondary analysis results were similar. The risk score developed allows accurate risk allocation (Harrell's C-statistic 0.71), with excellent calibration (Hosmer-Lemeshow ? statistics, P?=?0.99). A 12-fold (8.4-17.4) increased risk among those in the highest vs. lowest risk deciles was apparent.
Baseline SBP and choice of subsequent antihypertensive therapy were the two most important determinants of resistant hypertension in the ASCOT population. Individuals at high risk of developing resistant hypertension can be easily identified using an integer-based risk score.
PubMed ID
21881528 View in PubMed
Less detail

Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature175728
Source
Drugs. 2004;64 Suppl 2:43-60
Publication Type
Article
Date
2004
Author
Peter S Sever
Björn Dahlöf
Neil R Poulter
Hans Wedel
Gareth Beevers
Mark Caulfield
Rory Collins
Sverre E Kjeldsen
Arni Kristinsson
Gordon T McInnes
Jesper Mehlsen
Markku Nieminen
Eoin O'Brien
Jan Ostergren
Author Affiliation
Imperial College, London, UK.
Source
Drugs. 2004;64 Suppl 2:43-60
Date
2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cholesterol - blood
Coronary Disease - mortality - prevention & control
Endpoint Determination
Female
Great Britain
Heptanoic Acids - therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypertension - complications
Male
Middle Aged
Myocardial Infarction - epidemiology - prevention & control
Proportional Hazards Models
Pyrroles - therapeutic use
Scandinavia
Stroke - mortality - prevention & control
Treatment Outcome
Abstract
The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed dyslipidaemic.
Of 19 342 hypertensive patients (aged 40-79 years with at least three other cardiovascular risk factors) randomised to one of two antihypertensive regimens in the Anglo-Scandinavian Cardiac Outcomes Trial, 10,305 with nonfasting total cholesterol concentrations 6.5 mmol/L or less were randomly assigned additional atorvastatin 10 mg or placebo. These patients formed the lipid-lowering arm of the study. We planned follow-up for an average of 5 years, the primary endpoint being non-fatal myocardial infarction and fatal CHD. Data were analysed by intention to treat.
Treatment was stopped after a median follow-up of 3.3 years. By that time, 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group (hazard ratio 0.64 [95% CI 0.50-0.83], p = 0.0005). This benefit emerged in the first year of follow-up. There was no significant heterogeneity among prespecified subgroups. Fatal and non-fatal stroke (89 atorvastatin vs 121 placebo, 0.73 [0.56-0.96], p = 0.024), total cardiovascular events (389 vs 486, 0.79 [0.69-0.90], p = 0.0005), and total coronary events (178 vs 247, 0.71 [0.59-0.86], p = 0.0005) were also significantly lowered. There were 185 deaths in the atorvastatin group and 212 in the placebo group (0.87 [0.71-1.06], p = 0.16). Atorvastatin lowered total serum cholesterol by about 1.3 mmol/L compared with placebo at 12 months, and by 1.1 mmol/L after 3 years of follow-up.
The reductions in major cardiovascular events with atorvastatin are large, given the short follow-up time. These findings may have implications for future lipid-lowering guidelines.
PubMed ID
15765890 View in PubMed
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The value of N-terminal pro-B-type natriuretic peptide in determining antihypertensive benefit: observations from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).

https://arctichealth.org/en/permalink/ahliterature105751
Source
Hypertension. 2014 Mar;63(3):507-13
Publication Type
Article
Date
Mar-2014
Author
Paul Welsh
Neil R Poulter
Choon L Chang
Peter S Sever
Naveed Sattar
Author Affiliation
BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Pl, Glasgow G12 8TA, United Kingdom. Paul.Welsh@glasgow.ac.uk or Naveed.Sattar@glasgow.ac.uk.
Source
Hypertension. 2014 Mar;63(3):507-13
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Aged
Antihypertensive Agents - therapeutic use
Biological Markers - blood
Blood Pressure - drug effects
Female
Follow-Up Studies
Great Britain - epidemiology
Humans
Hypertension - blood - drug therapy - epidemiology
Male
Middle Aged
Natriuretic Peptide, Brain - blood
Odds Ratio
Peptide Fragments - blood
Prevalence
Prognosis
Protein Precursors
Retrospective Studies
Risk Assessment - methods
Risk factors
Scandinavia - epidemiology
Time Factors
Abstract
We investigated 3 hypotheses: (1) N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts cardiovascular disease events in patients with hypertension, (2) NT-proBNP is associated with blood pressure variability, and (3) NT-proBNP predicts benefit from antihypertensive regimens. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) randomized a subset of 6549 patients at risk with no history of coronary heart disease to either atenolol-based or amlodipine-based blood pressure-lowering treatment. During 5.5 years of follow-up, 485 cardiovascular disease cases accrued and were matched with 1367 controls. Baseline and 6-month in-trial NT-proBNP were measured. The results show that NT-proBNP improves cardiovascular disease risk prediction beyond established predictors, continuous net reclassification improvement of 22.3% (P
Notes
Comment In: Hypertension. 2014 Apr;63(4):e8724535010
PubMed ID
24324046 View in PubMed
Less detail