Evidence born from ASCOT trial – still important after 15 years

Abstract

The paper presents the overview evolution of hypertension identification and treatment during last 15 years after publication of ASCOT trial (AngloScandinavian Cardiac Outcomes Trial) results. It discusses possible mechanism of more significant cardiovascular risk reduction in amlodipine/ perindopril group comparing with atenolol/diuretic group: central blood pressure, arterial stiffness, asleep blood pressure and BP variability. Innovative approaches in time of ASCOТ trial such as combined antihypertensive therapy from start and RAAS inhibitor as first line now became routine practice in actual guidelines. Importance of early prescribing of fixed antihypertensive combination and choice of safe drugs help to improve adherence and decrease resistant hypertension prevalence. Prevention of new onset of diabetes in metabolic patients needs application of metabolically neutral drugs and including of renin-angiotensin-aldosterone inhibitors in combination therapy. Results of ASCOT-Legacy trial demonstrated long-term protective effect of amlodipine/perindopril combination resulting in decreasing mortality, rate of stroke and coronary events during 20-years follow-up.