Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 56, Issue 1, Pages 77-85Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2010.02.046
Keywords
amlodipine; coronary events; diabetes; hydrochlorothiazide; hypertension
Categories
Funding
- Novartis
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Daiichi Sankyo
- Forest Pharmaceuticals
- GlaxoSmithKline
- Sanofi-Aventis
- Gilead
- Takeda Pharmaceuticals
- Merck
- Takeda
- Abbott Laboratories
- Walgreen's
- BMS/Sanofi
- Juvenile Diabetes Research Foundation
- Forest Labs
- CVRx
- NIH
- NIDDK
- NHLBI
- King Pharmaceuticals
- AstraZeneca
- Bayer
- Menarini
- Sanofi
- Servier
- Cardio-Kinetix
- NovaCardia
- Medtronic Foundation
- Pfizer
- Ono
- Medtronic
- Sankyo
Ask authors/readers for more resources
Objectives The aim of this study was to determine which combination therapy in patients with hypertension and diabetes most effectively decreases cardiovascular events. Background The ACCOMPLISH (Avoiding Cardiovascular Events Through COMbination Therapy in Patients Living With Systolic Hypertension) trial compared the outcomes effects of a renin-angiotensin system blocker, benazepril, combined with amlodipine (B + A) or hydrochlorothiazide (B + H). A separate analysis in diabetic patients was pre-specified. Methods A total of 6,946 patients with diabetes were randomized to treatment with B + A or B + H. A subgroup of 2,842 diabetic patients at very high risk (previous cardiovascular or stroke events) was also analyzed, as were 4,559 patients without diabetes. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for angina, resuscitated arrest, and coronary revascularization. Results In the full diabetes group, the mean achieved blood pressures in the B + A and B + H groups were 131.5/72.6 and 132.7/73.7 mm Hg; during 30 months, there were 307 (8.8%) and 383 (11.0%) primary events (hazard ratio [HR]: 0.79, 95% confidence interval [CI]: 0.68 to 0.92, p = 0.003). For the diabetic patients at very high risk, there were 195 (13.6%) and 244 (17.3%) primary events (HR: 0.77, 95% CI: 0.64 to 0.93, p = 0.007). In the nondiabetic patients, there were 245 (10.8%) and 296 (12.9%) primary events (HR: 0.82, 95% CI: 0.69 to 0.97, p = 0.020). In the diabetic patients, there were clear coronary benefits with B + A, including both acute clinical events (p = 0.013) and revascularizations (p = 0.024). There were no unexpected adverse events. Conclusions In patients with diabetes and hypertension, combining a renin-angiotensin system blocker with amlodipine, compared with hydrochlorothiazide, was superior in reducing cardiovascular events and could influence future management of hypertension in patients with diabetes. (Avoiding Cardiovascular Events Through COMbination Therapy in Patients Living With Systolic Hypertension [ACCOMPLISH]; NCT00170950) (J Am Coll Cardiol 2010; 56: 77-85) (C) 2010 by the American College of Cardiology Foundation
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available