From the American Society of Hypertension 22nd Annual Scientific Meeting and Exposition: ACCOMPLISH: Investigators note 'unprecedented' levels of blood pressure control with benazepril plus either amlodipine or hydrochlorothiazide at 18 months

Key Points

In the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) study, initial treatment of hypertension with a fixed-dose, dual-drug combination demonstrated "unprecedented" levels of control at 18 months, according to Kenneth Jamerson, MD, professor, department of internal medicine, University of Michigan, Ann Arbor.

The 18-month results of this international study were presented at the American Society of Hypertension 22nd Annual Scientific Meeting and Exposition.

A total of 11,400 patients are enrolled in the ongoing study that is designed to compare the effects of benazepril/amlodipine with those of benazepril/hydrochlorothiazide on major fatal and nonfatal cardiovascular events among patients with hypertension. All patients were aged ≥55 years, had a baseline systolic blood pressure (SBP) of ≥160 mmHg or were receiving antihypertensive drug therapy, and had evidence of cardiovascular or renal disease or target-organ damage. Outcomes data are expected in 2008.

Dr Jamerson said the quick initiation of aggressive therapy is in contrast to the traditional treatment approach that has urged physicians to "start low and go slow," but Dr Jamerson said that the newer thinking makes more sense. "A new paradigm shift is to use combination therapy at the initiation of treatment to try to get better outcomes."

Combination therapy, according to the most recent National Heart Lung and Blood Institute (NHLBI) treatment guidelines, should be reserved for patients with untreated blood pressures ≥160/100 mmHg, or with stage 2 hypertension, Dr Jamerson said. The treatment guidelines recommend the addition of a thiazide diuretic as 1 component of this 2-drug combination therapy.

A total of 97% of the enrolled patients were previously treated for hypertension, and 74% of the patients were treated with ≥2 antihypertensive agents. Despite this treatment, the mean baseline SBP for all patients was 145.4 mmHg.

Treatment doses for all patients were titrated to achieve target blood pressures <140/90 mmHg (<130/80 mmHg in patients with diabetes or renal insufficiency).

Overall, patients experienced a mean decline in SBP to 132.5 mmHg at 6 months of treatment. At 18 months, the mean SBP for all patients was 131.8 mmHg. Among patients with diabetes (n=6,921), SBP decreased from 145.2 mmHg at baseline to 131.5 mmHg at 18 months. Among patients with chronic kidney disease (n=680), SBP was reduced from 148.7 mmHg at baseline to 136.2 mmHg at 18 months.

The study is still blinded; therefore, blood-pressure reductions have not yet been stratified based on treatment.

The percentage of patients with controlled blood pressures (<140/90 mmHg) increased from 37.5% at baseline to 75.6% at 18 months and reached 80.5% in the US study population (n=8,067).

The majority of patients achieved blood pressure control with the study drug only, but approximately 33% of patients were administered add-on therapy to try to achieve blood pressure goals.

SOURCE

The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7). National Heart Lung and Blood Institute website. 2003. http:// http://www.nhlbi.nih.gov/guidelines/hypertension/index.htm. Accessed June 13, 2007.