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[The ACCOMPLISH trial: are results really unexpected?]

Bernard Waeber1, François Feihl

  • 1Division de physiopathologie clinique, Département de médecine, CHUV- MP 14/204, 1011 Lausanne. Bernard.Waeber@chuv.ch

Revue Medicale Suisse
|February 17, 2009
PubMed

Insights

The ACCOMPLISH trial found that combining benazepril with amlodipine significantly reduced cardiovascular death and heart attacks in hypertensive patients compared to benazepril with hydrochlorothiazide.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Context:

  • Hypertension management in high cardiovascular risk patients.
  • Evaluating fixed-dose combination therapies for blood pressure control.
  • Assessing long-term morbidity and mortality outcomes.

Purpose:

  • To compare the efficacy of benazepril plus amlodipine (B+A) versus benazepril plus hydrochlorothiazide (B+HCTZ) in reducing cardiovascular events.
  • To determine the effectiveness of two antihypertensive regimens in achieving target blood pressure.
  • To analyze the impact on cardiovascular mortality, myocardial infarction, and revascularization.

Summary:

  • The ACCOMPLISH trial randomized 11,506 high-risk hypertensive patients to receive either B+A or B+HCTZ.
  • Target blood pressure (<140/90 mmHg) was achieved in 75.4% of patients on B+A versus 72.4% on B+HCTZ after 6 months.
  • Over 3 years, B+A significantly reduced cardiovascular mortality (-20%), myocardial infarction (-22%), and coronary revascularization (-14%) compared to B+HCTZ.

Impact:

  • The benazepril plus amlodipine regimen demonstrates superior effectiveness in preventing major adverse cardiovascular events.
  • Results support the use of specific drug combinations for optimizing cardiovascular risk reduction in hypertensive populations.
  • This study provides crucial evidence for clinical guidelines on antihypertensive therapy selection.

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