Two drugs in a single pill helps most high-risk hypertensives achieve pressures below 140/90 mm Hg.


CHICAGO—At least three of every four high-risk hypertensive patients started on single-tablet, fixed-dose, dual-mechanism therapy achieve the recommended target BP of less than 140/90 mm Hg after 18 months, according to preliminary results of an ongoing global trial.

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The findings, presented here at the 22nd Annual Meeting of the American Society of Hypertension, are from the Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial. It is the first outcomes study of initial therapy with fixed-dose combination BP treatment. The study concludes next year.


“More than 38 million Americans take antihypertensive medication but do not achieve blood pressure control,” said principal investigator Kenneth Jamerson, MD, professor of internal medicine at the University of Michigan Medical Center in Ann Arbor. “We have shown that initial therapy with single-tablet, dual-mechanism therapy is highly effective and safe.”


The trial randomized 11,463 hypertensive patients to a fixed-dose combination of either amlodipine besylate/benazepril hydrochloride or benazepril hydrochloride/hydrochlorothiazide.  The investigators hypothesized that the amlodipine/benazepril combination would reduce cardiovascular morbidity and mortality in the study population by 15% compared with benazepril/hydrochlorothiazide.


Participants were men or women of any racial background who were at least 55 years old and had systolic BP of 160 mm Hg or greater or were currently on antihypertensive therapy. All were at high risk of vascular disease because of established CVD or diabetes.


Although 97% of the patients were taking BP medications before enrolling in the trial and 75% of them were receiving at least two drugs, only 37% achieved BP below 140/90 mm Hg. After 18 months of treatment, overall control rates increased to 76%, Dr. Jamerson said. Mean systolic pressure dropped to 131 mm Hg from 145 mm Hg at baseline. Improvements were similar irrespective of age and gender.


The results were even more dramatic in U.S. participants, with more than 80% of those patients achieving systolic pressure reductions to below 140 mm Hg (mean 129 mm Hg). Gender, age, and ethnicity had no effect on the magnitude of BP reduction.


“While the traditional approach to hypertension management had been to start patients on one medicine, increase the dose, and then add on additional medications as needed, we now have significant data which demonstrate the value of treating high-risk hypertensive patients with a fixed-dose combination from the start,” Dr. Jamerson commented.