20 Aug The ASCOT trial: a closer look
Norman M. KaplanJournal of Hypertension 2006, 24:211-214
The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
Correspondence and requests for reprints to Norman M. Kaplan, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8899, USA
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The results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOTBPLA)  are a major addition to our understanding of the appropriate way to provide antihypertensive drug therapy for hypertension. Although it is true that, in all previously published trials, an admixture of additional drugs with the initial agent being studied has been invariable, sometimes reaching 80% of the enrollers , ASCOT-BPLA is the first published study purposely designed to compare combinations of ‘older’ drugs (i.e. a b-blocker followed by a diuretic) versus ‘newer’ drugs [i.e. a calcium channel blocker (CCB) followed by an angiotensin-converting enzyme inhibitor (ACEI)].
The data show a significantly greater protection against various cardiovascular diseases by the CCB followed by ACEI regimen than by the b-blocker followed by diuretic regimen. In addition to the papers published in the Lancet [1,3], the authors have portrayed the rather tortured manner by which the trial was designed and the rather Herculian efforts expended to bring it to completion . Beyond a good amount of such background information, all of the important findings are to be found in the papers published in the Lancet [1,3].