Related Experiment Videos

Cardiovascular events during differing hypertension therapies in patients with diabetes

Michael A Weber1, George L Bakris, Kenneth Jamerson

  • 1Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York 11203, USA. michaelwebermd@cs.com

Journal of the American College of Cardiology
|July 13, 2010
PubMed

Insights

For patients with diabetes and hypertension, the combination of benazepril and amlodipine (B+A) significantly reduced cardiovascular events compared to benazepril and hydrochlorothiazide (B+H). This therapy offers superior cardiovascular protection for diabetic hypertensive patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Pharmacology

Background:

  • The ACCOMPLISH trial investigated combination therapies for hypertension.
  • A pre-specified analysis focused on diabetic patients within the trial.
  • Renin-angiotensin system blockers were compared with amlodipine (B+A) or hydrochlorothiazide (B+H).

Purpose of the Study:

  • To determine the most effective combination therapy for reducing cardiovascular events in patients with both hypertension and diabetes.
  • To compare the efficacy of benazepril plus amlodipine versus benazepril plus hydrochlorothiazide in this patient population.

Main Methods:

  • Randomized controlled trial involving 6,946 patients with diabetes.
  • Subgroup analyses included very high-risk diabetic patients and non-diabetic patients.
  • Primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, and other major cardiovascular events.

Main Results:

  • The B+A combination showed a significant reduction in primary events in the full diabetes group (8.8% vs. 11.0%, HR 0.79, p=0.003).
  • Similar benefits were observed in very high-risk diabetic patients (13.6% vs. 17.3%, HR 0.77, p=0.007) and non-diabetic patients (10.8% vs. 12.9%, HR 0.82, p=0.020).
  • B+A demonstrated clear coronary benefits, including reduced acute events and revascularizations in diabetic patients, with no increased adverse events.

Conclusions:

  • Combination therapy with benazepril and amlodipine is superior to benazepril and hydrochlorothiazide for managing cardiovascular risk in patients with diabetes and hypertension.
  • These findings suggest a potential shift in hypertension management strategies for diabetic patients.
  • The study supports the use of B+A for improved cardiovascular outcomes in this high-risk group.
Abstract

Related Concept Videos

Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
Hypertension V: Nursing Management01:23

Hypertension V: Nursing Management

The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
Alterations in Blood Pressure01:30

Alterations in Blood Pressure

Alterations in blood pressure, such as hypertension (high blood pressure) and hypotension (low blood pressure), significantly affect human health. Understanding these conditions' classifications, causes, and symptoms is essential for effective management and treatment.
Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart beats)...
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
Hypertension and Regulation of Blood Pressure01:18

Hypertension and Regulation of Blood Pressure

Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
Hypertension II: Pathophysiology01:29

Hypertension II: Pathophysiology

Hypertension is a chronic condition in which the blood's force against artery walls is excessively high, posing risks such as heart disease. The condition's underlying mechanisms involve complex interactions among the cardiovascular, kidney, and autonomic nervous systems.Renin-Angiotensin-Aldosterone System (RAAS): This system significantly influences blood pressure regulation. When blood pressure decreases, the kidneys secrete renin. This enzyme transforms angiotensinogen, a plasma protein,...