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


CONCLUSIONS
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).
Department of Medicine, Karolinska University Hospital Solna, Stockholm, Sweden. jan.ostergren@karolinska.se
Jan
J
Ostergren
Neil R
NR
Poulter
Peter S
PS
Sever
Björn
B
Dahlöf
Hans
H
Wedel
Gareth
G
Beevers
Mark
M
Caulfield
Rory
R
Collins
Sverre E
SE
Kjeldsen
Arni
A
Kristinsson
Gordon T
GT
McInnes
Jesper
J
Mehlsen
Markku
M
Nieminen
Eoin
E
O'Brien
D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use; D016491:Peripheral Vascular Diseases / Q000517:prevention & control; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D020521:Stroke / Q000517:prevention & control; D049971:Thiazides / Q000627:therapeutic use; D006113:United Kingdom / Q000453:epidemiology
D000959:Antihypertensive Agents; D049971:Thiazides; D017311:Amlodipine; D001262:Atenolol; D020913:Perindopril