This article is more than 5 years old. Information may no longer be current.
ACCOMPLISH: Benazepril plus amlodipine lowered rate of CV events
The combination of a calcium channel blocker with an ACE inhibitor reduced CV events more effectively than a diuretic with an ACE inhibitor.
Click Here to Manage Email Alerts
Patients with hypertension assigned a combination of benazepril plus amlodipine had better outcomes than those assigned a combination of benazepril plus hydrochlorothiazide.
Researchers for the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial enrolled 11,506 patients with hypertension into the randomized, double blind trial. The patients were assigned to either benazopril plus amlodipine (n=5,744) or benazopril plus hydrochlorothiazide (n=5,762). The primary endpoint of the study was defined as a composite of the time to the first CV event or death from CV causes, with a prespecified secondary endpoint of a composite of CV events excluding fatal events. The trial was terminated prematurely after 36 months of follow-up when the data safety and monitoring board determined that the boundary of the prespecified stopping rule was exceeded.
According to the researchers, mean BP following dose adjustment was 131.6 mm Hg/73.3 mm Hg in the benazepril plus amlodipine (Lotrel, Novartis) group and 132.5 mm Hg/74.4 mm Hg in the benazepril plus hydrochlorothiazide (Lotensin HCT, Novartis) group. The primary endpoint occurred in 552 (9.6%) patients in the benazepril plus amlodipine group (n=5,463) vs. 679 (11.8%) patients in the benazepril plus hydrochlorothiazide group (n=5,474), with an RR reduction of 19.6% (HR=0.80; 95% CI, 0.72-0.90). There were also fewer fatal and nonfatal MIs in the benazepril plus amlodipine group vs. the benazepril plus hydrochlorothiazide group (RR reduction=21.5%; P=.04) and fewer coronary revascularization procedures (RR reduction=13.9%; P=.04).
“Our trial shows that combination therapy with benazepril and amlodipine results not only in excellent BP control but also in a clear benefit with respect to CV outcomes,” the researcher wrote. “Thus, our findings may increase the options for combination treatment to reduce the risk for CV events among patients with hypertension.” – by Eric Raible
For more information:
- N Engl J Med. 2008;359:2417-2428.