Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients
- PDF / 168,529 Bytes
- 2 Pages / 612 x 792 pts (letter) Page_size
- 50 Downloads / 146 Views
Benazepril Plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients Jamerson K, Weber MA, Bakris GL, et al.: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008, 359:2417–2428. Rating: ••Of major importance. Introduction: Early clinical trials in hypertension compared monotherapy with a specifi c drug against placebo. The overwhelming evidence for benefit of treating hypertension has led, more recently, to trials comparing different drug classes as antihypertensive monotherapy. As a result of these trials, thiazide diuretics have been recommended as the most effective and cost-effective agents for fi rst-line therapy, or early adjunctive therapy, for most patients with uncomplicated hypertension. However, data have been sparse regarding the comparative efficacy of popular alternative fi xed-dose combinations, such as angiotensin-converting enzyme (ACE) inhibitors combined with calcium channel blockers or thiazides. Aims: The Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) study was designed to test the hypothesis that treatment with an ACE inhibitor combined with amlodipine would result in better cardiovascular disease (CVD) outcomes than treatment with the same ACE inhibitor combined with a thiazide diuretic in patients at high risk for CVD. Methods: ACCOMPLISH was a multicenter, doubleblind, active-treatment clinical trial performed in five countries (Sweden, Norway, Denmark, Finland, and the United States). The study enrolled patients with hypertension who were deemed to be at high risk. Inclusion criteria were age ≥ 60 years, treated hypertension or systolic blood pressure ≥ 160 mm Hg, and the presence of at least one of the following as evidence of target organ damage: documented symptomatic coronary artery disease, prior stroke, symptomatic or revascularized peripheral arterial disease, diabetes mellitus, electrocardiographic left ventricular hypertrophy, or renal disease (including elevated creatinine or macroalbuminuria). Participants were randomized to receive a single pill with either 20 mg of benazepril and 5 mg of amlodipine or with 20 mg of benazepril and 12.5 mg
of hydrochlorothiazide (HCTZ). There was no washout of the prior antihypertensive regimen (it was stopped when the treatment regimen for the trial was begun), but investigators subsequently stated that patients with indications for β -blockers could continue to receive them. After 1 month, the dose of benazepril was titrated to 40 mg daily in both groups. Subsequent dose adjustments of amlodipine to 10 mg daily or HCTZ to 25 mg daily were allowed in order to achieve goal blood pressures of below 140/90 mm Hg (or < 130/80 mm Hg in those with diabetes or kidney disease). Adjunctive therapy with β -blockers, α -blockers, clonidine, and spironolactone was allowed after patients were on the maximal allowed doses of the combination pills, and once-daily loop diuretics were allowed for volume management.
Data Loading...
