Cardiovascular Events During Differing Hypertension Therapies in Patients With Diabetes

• Published in: Journal of the American College of Cardiology 2010-06, Vol.56 (1), p.77-85
• Main Authors: Weber, Michael A., MD, Bakris, George L., MD, Jamerson, Kenneth, MD, Weir, Matthew, MD, Kjeldsen, Sverre E., MD, Devereux, Richard B., MD, Velazquez, Eric J., MD, Dahlöf, Björn, MD, Kelly, Roxzana Y., MS, Hua, Tsushung A., PhD, Hester, Allen, PhD, Pitt, Bertram, MD
• Format: Article
• Language: English
• Subjects: Aged; amlodipine; Amlodipine - administration & dosage; Amlodipine - adverse effects; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - adverse effects; Arterial hypertension. Arterial hypotension; Benzazepines - administration & dosage; Benzazepines - adverse effects; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Cardiology; Cardiology. Vascular system; Cardiovascular; Confidence intervals; Coronary Disease - prevention & control; coronary events; Diabetes; Diabetes Complications - drug therapy; Diabetes. Impaired glucose tolerance; Drug dosages; Drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Heart attacks; Heart failure; Hospitalization; Humans; hydrochlorothiazide; Hydrochlorothiazide - administration & dosage; Hypertension; Hypertension - drug therapy; Hypertension - physiopathology; Internal Medicine; Kidney diseases; Male; Medical sciences; Mortality; Patients; Risk Factors; Stroke; Studies
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.02.046

Objectives The aim of this study was to determine which combination therapy in patients with hypertension and diabetes most effectively decreases cardiovascular events. Background The ACCOMPLISH (Avoiding Cardiovascular Events Through COMbination Therapy in Patients Living With Systolic Hypertension) trial compared the outcomes effects of a renin-angiotensin system blocker, benazepril, combined with amlodipine (B+A) or hydrochlorothiazide (B+H). A separate analysis in diabetic patients was pre-specified. Methods A total of 6,946 patients with diabetes were randomized to treatment with B+A or B+H. A subgroup of 2,842 diabetic patients at very high risk (previous cardiovascular or stroke events) was also analyzed, as were 4,559 patients without diabetes. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for angina, resuscitated arrest, and coronary revascularization. Results In the full diabetes group, the mean achieved blood pressures in the B+A and B+H groups were 131.5/72.6 and 132.7/73.7 mm Hg; during 30 months, there were 307 (8.8%) and 383 (11.0%) primary events (hazard ratio [HR]: 0.79, 95% confidence interval [CI]: 0.68 to 0.92, p = 0.003). For the diabetic patients at very high risk, there were 195 (13.6%) and 244 (17.3%) primary events (HR: 0.77, 95% CI: 0.64 to 0.93, p = 0.007). In the nondiabetic patients, there were 245 (10.8%) and 296 (12.9%) primary events (HR: 0.82, 95% CI: 0.69 to 0.97, p = 0.020). In the diabetic patients, there were clear coronary benefits with B+A, including both acute clinical events (p = 0.013) and revascularizations (p = 0.024). There were no unexpected adverse events. Conclusions In patients with diabetes and hypertension, combining a renin-angiotensin system blocker with amlodipine, compared with hydrochlorothiazide, was superior in reducing cardiovascular events and could influence future management of hypertension in patients with diabetes. (Avoiding Cardiovascular Events Through COMbination Therapy in Patients Living With Systolic Hypertension [ACCOMPLISH]; NCT00170950 )