Is amlodipine the best initial monotherapy for hypertension?

Abstract

Hypertension is the principle cause of stroke, and leads to coronary artery disease with myocardial infarction and sudden cardiac death. The ASCOT–BPLA (Anglo-Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm) trial has recently shown that an amlodipine-based regimen (with perindopril and doxazosin added as required) has greater benefits than an atenolol-based regimen (with bendroflumethiazide and doxazosin). Thus, with the amlodipine-based regimen there was less nonfatal myocardial infarction and fatal heart disease, total cardiovascular events and procedures, cardiovascular mortality, fatal and nonfatal stroke, unstable angina, peripheral arterial disease, development of diabetes and renal impairment. Thus, the amlodipine-based regimen used in ASCOT–BPLA should be preferred to the atenolol-based regimen.

Keywords::

• amlodipine
• atenolol
• bendroflumethiazide
• clinical trial
• doxazosin
• hypertension
• perindopril