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Slower progression to kidney disease noted with antihypertensive combo

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Amlodipine plus benazepril was more effective than hydrochlorothiazide plus benazepril at reducing CV events in high-risk patients with hypertension and resulted in slower progression to chronic kidney disease, results from a secondary analysis of the ACCOMPLISH trial results indicated.

“Initial antihypertensive treatment with benazepril plus amlodipine (Lotrel, Novartis) should be considered in preference to benazepril plus hydrochlorothiazide (Lotensin, Novartis) since it slows progression of nephropathy to a greater extent,” the researchers wrote.

They randomly assigned 11,506 patients at a 1:1 ratio to a once daily oral regimen consisting of either benazepril (20 mg) plus amlodipine (5 mg; n=5,744) or benazepril (20 mg) plus hydrochlorothiazide (12.5 mg; n=5,762) and performed patient follow-up at a mean of 2.9 years; 143 patients were lost to follow-up. More patients in the benazepril plus amlodipine group achieved BP control compared with patients in the benazepril plus hydrochlorothiazide group (75% vs. 72%).

End-stage renal disease (measured by the first event of serum creatinine concentration doubling) and need for chronic dialysis (estimated glomerular filtration rate <15mL/min/1.73m²) were analyzed as part of an intention-to-treat kidney disease endpoint. Data indicated that patients in the amlodipine group experienced fewer progression to chronic kidney disease events (n=113) than those in the hydrochlorothiazide group (n=73; HR=0.52; P<.0001). Among patients with chronic kidney disease, peripheral edema was the most frequently experienced adverse event in either treatment group, whereas patients in the amlodipine group more frequently experienced angio-edema.

“A prospective study in patients with more advanced proteinuric nephropathy is needed to establish the superiority between these two different antihypertensive combination treatments on progression of chronic kidney disease,” the researchers wrote.

Bakris GL. Lancet. 2010;doi:10.1016/S0140-6736(09)62100-0.

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