Lessons from ASCOT-BPLA

There was a study named ASCOT from the Scandinavian countries, comprising the LLA (Lipid lowering arm) and BPLA (BP lowering arm). The ASCOT-BPLA, studying almost 20,000pts, was terminated in Nov 2004 when the differences in BP control between Norvasc + Perindopril and Atenolol + diuretics, were obvious and significant. This was reported to us in 2005.

At the just concluded ESC/WCC meeting at Barcelona, the investigators noted that almost 10% of the study cohort, who were not diabetic earlier, became diabetic during the study. The diabetic risk factors include, people who had pre-diabetes levels of blood sugar at the start of study, people who were hypertensive, and also people who were taking atenolol. I suppose we now know that taking beta-blockers chronically, is a risk factor for developing diabetes.

I wondered whether it would be correct to add that taking perindopril or amlodipine is a protection against diabetes. ACEI in particular, are now well documented to protect against T2DM, as was well shown in HOPE and PROGRESS. By extension, the ARB T2DM protective effect was also seen in VALUE (a comparison of Valsartan and Amlodipine), in the Valsartan arm. In fact the VALUE will make it less likely for Amlodipine to be T2DM protective. Conceptually, there are strong theorectical basis if one will consider that both T2DM and hypertension are diseases with strong inflammatory components, and that ACE-I and ARBs, like Statins, are in some ways, also anti-inflammatory. Interesting, isn't it.