Prior Medications and the Cardiovascular Benefits From Combination Angiotensin-Converting Enzyme Inhibition Plus...

Area of Science:

• Cardiology
• Pharmacology
• Hypertension Management

Background:

• The ACCOMPLISH trial compared amlodipine plus benazepril versus hydrochlorothiazide plus benazepril in high-risk hypertensive patients.
• The impact of prior antihypertensive therapies on trial outcomes was not extensively studied.

Purpose of the Study:

• To conduct a post hoc analysis of the ACCOMPLISH trial.
• To examine how pre-existing antihypertensive drug regimens influenced cardiovascular outcomes.

Main Methods:

• A subgroup analysis focused on patients previously on renin-angiotensin system blockade plus a diuretic or calcium channel blocker.
• A secondary analysis included all other participants with different prior antihypertensive regimens.
• Cox proportional hazard models were used to assess the primary composite outcome.

Main Results:

• In the primary subgroup, amlodipine plus benazepril showed a 26% reduction in primary composite events compared to hydrochlorothiazide plus benazepril (HR 0.74, P=0.0015).
• All other participants also benefited from amlodipine plus benazepril, with a 16% reduction in events (HR 0.84, P=0.024).
• Similar benefits were observed across subgroups based on prior lipid-lowering medication use and blood pressure control.

Conclusions:

• Combination therapy with amlodipine and an angiotensin-converting enzyme inhibitor (benazepril) is superior to hydrochlorothiazide plus benazepril for cardiovascular risk reduction.
• This benefit is largely independent of the patient's prior medication history.
• The findings support the use of amlodipine plus benazepril as an initial regimen for high-risk hypertensive patients.