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Avoiding Cardiovascular Complications in People Living With Systolic Hypertension, The ACCOMPLISH Trial
Author(s) -
Jamerson Kenneth A
Publication year - 2010
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.24.1_supplement.313.2
Subject(s) - medicine , hydrochlorothiazide , amlodipine , blood pressure , randomization , myocardial infarction , angina , cardiology , randomized controlled trial , clinical endpoint , diuretic , polypill , unstable angina , disease
Background ACCOMPLISH is the first trial to use combination therapy for the initial treatment of high‐risk hypertensive patients. The single hypothesis, the combination of amlodipine/benazapril will be superior to hydrochlorothiazide/benazapril in reducing CV morbidity and mortality challenges two standards of care in treating hypertensive patients (monotherapy and diuretic based therapy). Methods 11,442 patients were recruited in the US and Scandinavia after meeting inclusion criteria for higher CV risk. Subjects began study medication after randomization without washout or run in periods. Randomization procedures were centralized and double blinded. The planned mean observation of 36 months had 90% power to detect a 15% reduction in the composite end point (CV mortality, stroke, MI, coronary revascularization, unstable angina, and resuscitation from death). Results The Data Safety and Monitoring Committee observed that with 60% of the expected information for the trial, that an efficacy boundary for the primary end point had been crossed and recommended termination of the trial. Hypertension remains a leading cause of morbidity and mortality globally. While lowering blood pressure with any effective therapy reduces cardiovascular risk, the ACCOMPLISH trial found additional benefit attributable to a specific combination of antihypertensive medications. In particular, the combination of benazepril plus amlodipine was superior to the combination of benazepril plus hydrochlorothiazide in reducing cardiovascular disease events in high‐risk hypertensive subjects. Conclusion The results of the ACCOMPLISH trial provide evidence for a paradigm shift in the management of patients with hypertension.