Benazepril plus amlodipine reduced cardiovascular risk more than benazepril plus hydrochlorothiazide

摘要

QuestionnnIn high-risk patients with hypertension, does benazepril plus amlodipine prevent cardiovascular (CV) events more than benazepril plus hydrochlorothiazide (HCTZ)? nnMethodsnnDesign: Randomized controlled trial (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension [ACCOMPLISH]). ClinicalTrials.gov NCT00170950.nnAllocation: Concealed.*nnBlinding: Blinded (patients, clinicians, data collectors, and outcome adjudication committee).*nnFollow-up period: Mean 36 months (trial stopped early for apparent benefit).nnSetting: 548 centers in the USA, Sweden, Norway, Denmark, and Finland.nnPatients: 11 506 patients { 55 y of age}† (mean age 68 y, 61% men) who had hypertension and 1 of the following risk factors { 2 if < 60 y of age}†: diabetes, history of a CV event, creatinine > 133 µmol/L in women or > 150 µmol/L in men, macroalbuminuria, peripheral arterial disease, and left ventricular hypertrophy.nnIntervention: Benazepril, 20 mg, plus amlodipine, 5 mg (n = 5744), or benazepril, 20 mg, plus HCTZ, 12.5 mg (n = 5762), once daily. After 1 month, benazepril was increased to 40 mg/d in both groups. After 2 months, the dose of amlodipine or HCTZ could be doubled to attain a target blood pressure (BP) of 140/90 mm Hg.nnOutcomes: Primary composite endpoint (CV death, nonfatal myocardial infarction [MI] or stroke, hospitalization for unstable angina, coronary revascularization, or sudden cardiac arrest) and secondary composite endpoint (CV death or nonfatal MI or stroke).nnPatient follow-up: 99% (intention-to-treat analysis).nnnMain resultsnnMean baseline BP was 145/80 mm Hg; at the end of the trial, mean BP was 132/73 mm Hg in the benazepril plus amlodipine group and 133/74 mm Hg in the benazepril plus HCTZ group (P < 0.001). Benazepril plus amlodipine reduced risk for both composite endpoints (Table). nnConclusionnnIn high-risk patients with hypertension, benazepril plus amlodipine prevented cardiovascular events more than benazepril plus hydrochlorothiazide.