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Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial

Summary Background The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial showed that initial antihypertensive therapy with benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascul... Full description

Journal Title: The Lancet (British edition) 2010, Vol.375 (9721), p.1173-1181
Main Author: Bakris, George L, Dr, Prof
Other Authors: Sarafidis, Pantelis A, MD , Weir, Matthew R, Prof , Dahlöf, Björn, Prof , Pitt, Bertram, Prof , Jamerson, Kenneth, MD , Velazquez, Eric J, MD , Staikos-Byrne, Linda, PhD , Kelly, Roxzana Y, MS , Shi, Victor, MD , Chiang, Yann-Tong, PhD , Weber, Michael A, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial
format: Article
creator:
  • Bakris, George L, Dr, Prof
  • Sarafidis, Pantelis A, MD
  • Weir, Matthew R, Prof
  • Dahlöf, Björn, Prof
  • Pitt, Bertram, Prof
  • Jamerson, Kenneth, MD
  • Velazquez, Eric J, MD
  • Staikos-Byrne, Linda, PhD
  • Kelly, Roxzana Y, MS
  • Shi, Victor, MD
  • Chiang, Yann-Tong, PhD
  • Weber, Michael A, Prof
subjects:
  • Abridged Index Medicus
  • Aged
  • Albuminuria
  • 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
  • Blister packs
  • Blood and lymphatic vessels
  • Blood Pressure
  • Calcium Channel Blockers - administration & dosage
  • Calcium Channel Blockers - adverse effects
  • Cardiology. Vascular system
  • Cardiovascular Diseases - mortality
  • Cardiovascular Diseases - prevention & control
  • Chronic kidney failure
  • clinical trials
  • Creatinine - blood
  • Development and progression
  • Diabetes
  • Dialysis
  • Disease Progression
  • Diuretics - administration & dosage
  • Diuretics - adverse effects
  • Double-Blind Method
  • Drug Combinations
  • Drug therapy
  • Drug therapy, Combination
  • Drugs
  • Female
  • Filtration
  • General aspects
  • Glomerular Filtration Rate
  • Heart failure
  • Humans
  • Hydrochlorothiazide - administration & dosage
  • Hydrochlorothiazide - adverse effects
  • Hypertension
  • Hypertension - complications
  • Hypertension - drug therapy
  • Hypertension - physiopathology
  • Internal Medicine
  • Kidney
  • Kidney diseases
  • Kidney Failure, Chronic - complications
  • Kidney Failure, Chronic - physiopathology
  • Kidney Failure, Chronic - urine
  • Male
  • Medical sciences
  • Methods
  • Middle Aged
  • Mortality
  • Patient outcomes
  • Risk Factors
  • secondary analysis
  • Side effects
  • Studies
ispartof: The Lancet (British edition), 2010, Vol.375 (9721), p.1173-1181
description: Summary Background The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial showed that initial antihypertensive therapy with benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascular morbidity and mortality. We assessed the effects of these drug combinations on progression of chronic kidney disease. Methods ACCOMPLISH was a double-blind, randomised trial undertaken in five countries (USA, Sweden, Norway, Denmark, and Finland). 11 506 patients with hypertension who were at high risk for cardiovascular events were randomly assigned via a central, telephone-based interactive voice response system in a 1:1 ratio to receive benazepril (20 mg) plus amlodipine (5 mg; n=5744) or benazepril (20 mg) plus hydrochlorothiazide (12·5 mg; n=5762), orally once daily. Drug doses were force-titrated for patients to attain recommended blood pressure goals. Progression of chronic kidney disease, a prespecified endpoint, was defined as doubling of serum creatinine concentration or end-stage renal disease (estimated glomerular filtration rate
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleRenal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial
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creatorBakris, George L, Dr, Prof ; Sarafidis, Pantelis A, MD ; Weir, Matthew R, Prof ; Dahlöf, Björn, Prof ; Pitt, Bertram, Prof ; Jamerson, Kenneth, MD ; Velazquez, Eric J, MD ; Staikos-Byrne, Linda, PhD ; Kelly, Roxzana Y, MS ; Shi, Victor, MD ; Chiang, Yann-Tong, PhD ; Weber, Michael A, Prof
creatorcontribBakris, George L, Dr, Prof ; Sarafidis, Pantelis A, MD ; Weir, Matthew R, Prof ; Dahlöf, Björn, Prof ; Pitt, Bertram, Prof ; Jamerson, Kenneth, MD ; Velazquez, Eric J, MD ; Staikos-Byrne, Linda, PhD ; Kelly, Roxzana Y, MS ; Shi, Victor, MD ; Chiang, Yann-Tong, PhD ; Weber, Michael A, Prof ; for the ACCOMPLISH Trial investigators ; ACCOMPLISH Trial investigators
descriptionSummary Background The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial showed that initial antihypertensive therapy with benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascular morbidity and mortality. We assessed the effects of these drug combinations on progression of chronic kidney disease. Methods ACCOMPLISH was a double-blind, randomised trial undertaken in five countries (USA, Sweden, Norway, Denmark, and Finland). 11 506 patients with hypertension who were at high risk for cardiovascular events were randomly assigned via a central, telephone-based interactive voice response system in a 1:1 ratio to receive benazepril (20 mg) plus amlodipine (5 mg; n=5744) or benazepril (20 mg) plus hydrochlorothiazide (12·5 mg; n=5762), orally once daily. Drug doses were force-titrated for patients to attain recommended blood pressure goals. Progression of chronic kidney disease, a prespecified endpoint, was defined as doubling of serum creatinine concentration or end-stage renal disease (estimated glomerular filtration rate <15 mL/min/1·73 m2 or need for dialysis). Analysis was by intention to treat (ITT). This trial is registered with ClinicalTrials.gov , number NCT00170950. Findings The trial was terminated early (mean follow-up 2·9 years [SD 0·4]) because of superior efficacy of benazepril plus amlodipine compared with benazepril plus hydrochlorothiazide. At trial completion, vital status was not known for 143 (1%) patients who were lost to follow-up (benazepril plus amlodipine, n=70; benazepril plus hydrochlorothiazide, n=73). All randomised patients were included in the ITT analysis. There were 113 (2·0%) events of chronic kidney disease progression in the benazepril plus amlodipine group compared with 215 (3·7%) in the benazepril plus hydrochlorothiazide group (HR 0·52, 0·41–0·65, p<0·0001). The most frequent adverse event in patients with chronic kidney disease was peripheral oedema (benazepril plus amlodipine, 189 of 561, 33·7%; benazepril plus hydrochlorothiazide, 85 of 532, 16·0%). In patients with chronic kidney disease, angio-oedema was more frequent in the benazepril plus amlodipine group than in the benazepril plus hydrochlorothiazide group. In patients without chronic kidney disease, dizziness, hypokalaemia, and hypotension were more frequent in the benazepril plus hydrochlorothiazide group than in the benazepril plus amlodipine group. Interpretation Initial antihypertensive treatment with benazepril plus amlodipine should be considered in preference to benazepril plus hydrochlorothiazide since it slows progression of nephropathy to a greater extent. Funding Novartis.
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0Bakris, George L, Dr, Prof
1Sarafidis, Pantelis A, MD
2Weir, Matthew R, Prof
3Dahlöf, Björn, Prof
4Pitt, Bertram, Prof
5Jamerson, Kenneth, MD
6Velazquez, Eric J, MD
7Staikos-Byrne, Linda, PhD
8Kelly, Roxzana Y, MS
9Shi, Victor, MD
10Chiang, Yann-Tong, PhD
11Weber, Michael A, Prof
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13ACCOMPLISH Trial investigators
title
0Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial
1The Lancet (British edition)
addtitleLancet
descriptionSummary Background The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial showed that initial antihypertensive therapy with benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascular morbidity and mortality. We assessed the effects of these drug combinations on progression of chronic kidney disease. Methods ACCOMPLISH was a double-blind, randomised trial undertaken in five countries (USA, Sweden, Norway, Denmark, and Finland). 11 506 patients with hypertension who were at high risk for cardiovascular events were randomly assigned via a central, telephone-based interactive voice response system in a 1:1 ratio to receive benazepril (20 mg) plus amlodipine (5 mg; n=5744) or benazepril (20 mg) plus hydrochlorothiazide (12·5 mg; n=5762), orally once daily. Drug doses were force-titrated for patients to attain recommended blood pressure goals. Progression of chronic kidney disease, a prespecified endpoint, was defined as doubling of serum creatinine concentration or end-stage renal disease (estimated glomerular filtration rate <15 mL/min/1·73 m2 or need for dialysis). Analysis was by intention to treat (ITT). This trial is registered with ClinicalTrials.gov , number NCT00170950. Findings The trial was terminated early (mean follow-up 2·9 years [SD 0·4]) because of superior efficacy of benazepril plus amlodipine compared with benazepril plus hydrochlorothiazide. At trial completion, vital status was not known for 143 (1%) patients who were lost to follow-up (benazepril plus amlodipine, n=70; benazepril plus hydrochlorothiazide, n=73). All randomised patients were included in the ITT analysis. There were 113 (2·0%) events of chronic kidney disease progression in the benazepril plus amlodipine group compared with 215 (3·7%) in the benazepril plus hydrochlorothiazide group (HR 0·52, 0·41–0·65, p<0·0001). The most frequent adverse event in patients with chronic kidney disease was peripheral oedema (benazepril plus amlodipine, 189 of 561, 33·7%; benazepril plus hydrochlorothiazide, 85 of 532, 16·0%). In patients with chronic kidney disease, angio-oedema was more frequent in the benazepril plus amlodipine group than in the benazepril plus hydrochlorothiazide group. In patients without chronic kidney disease, dizziness, hypokalaemia, and hypotension were more frequent in the benazepril plus hydrochlorothiazide group than in the benazepril plus amlodipine group. Interpretation Initial antihypertensive treatment with benazepril plus amlodipine should be considered in preference to benazepril plus hydrochlorothiazide since it slows progression of nephropathy to a greater extent. Funding Novartis.
subject
0Abridged Index Medicus
1Aged
2Albuminuria
3Amlodipine - administration & dosage
4Amlodipine - adverse effects
5Angiotensin-Converting Enzyme Inhibitors - administration & dosage
6Angiotensin-Converting Enzyme Inhibitors - adverse effects
7Antihypertensive Agents - administration & dosage
8Antihypertensive Agents - adverse effects
9Arterial hypertension. Arterial hypotension
10Benzazepines - administration & dosage
11Benzazepines - adverse effects
12Biological and medical sciences
13Blister packs
14Blood and lymphatic vessels
15Blood Pressure
16Calcium Channel Blockers - administration & dosage
17Calcium Channel Blockers - adverse effects
18Cardiology. Vascular system
19Cardiovascular Diseases - mortality
20Cardiovascular Diseases - prevention & control
21Chronic kidney failure
22clinical trials
23Creatinine - blood
24Development and progression
25Diabetes
26Dialysis
27Disease Progression
28Diuretics - administration & dosage
29Diuretics - adverse effects
30Double-Blind Method
31Drug Combinations
32Drug therapy
33Drug therapy, Combination
34Drugs
35Female
36Filtration
37General aspects
38Glomerular Filtration Rate
39Heart failure
40Humans
41Hydrochlorothiazide - administration & dosage
42Hydrochlorothiazide - adverse effects
43Hypertension
44Hypertension - complications
45Hypertension - drug therapy
46Hypertension - physiopathology
47Internal Medicine
48Kidney
49Kidney diseases
50Kidney Failure, Chronic - complications
51Kidney Failure, Chronic - physiopathology
52Kidney Failure, Chronic - urine
53Male
54Medical sciences
55Methods
56Middle Aged
57Mortality
58Patient outcomes
59Risk Factors
60secondary analysis
61Side effects
62Studies
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2Weir, Matthew R, Prof
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4Pitt, Bertram, Prof
5Jamerson, Kenneth, MD
6Velazquez, Eric J, MD
7Staikos-Byrne, Linda, PhD
8Kelly, Roxzana Y, MS
9Shi, Victor, MD
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titleRenal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial
authorBakris, George L, Dr, Prof ; Sarafidis, Pantelis A, MD ; Weir, Matthew R, Prof ; Dahlöf, Björn, Prof ; Pitt, Bertram, Prof ; Jamerson, Kenneth, MD ; Velazquez, Eric J, MD ; Staikos-Byrne, Linda, PhD ; Kelly, Roxzana Y, MS ; Shi, Victor, MD ; Chiang, Yann-Tong, PhD ; Weber, Michael A, Prof
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2Albuminuria
3Amlodipine - administration & dosage
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5Angiotensin-Converting Enzyme Inhibitors - administration & dosage
6Angiotensin-Converting Enzyme Inhibitors - adverse effects
7Antihypertensive Agents - administration & dosage
8Antihypertensive Agents - adverse effects
9Arterial hypertension. Arterial hypotension
10Benzazepines - administration & dosage
11Benzazepines - adverse effects
12Biological and medical sciences
13Blister packs
14Blood and lymphatic vessels
15Blood Pressure
16Calcium Channel Blockers - administration & dosage
17Calcium Channel Blockers - adverse effects
18Cardiology. Vascular system
19Cardiovascular Diseases - mortality
20Cardiovascular Diseases - prevention & control
21Chronic kidney failure
22clinical trials
23Creatinine - blood
24Development and progression
25Diabetes
26Dialysis
27Disease Progression
28Diuretics - administration & dosage
29Diuretics - adverse effects
30Double-Blind Method
31Drug Combinations
32Drug therapy
33Drug therapy, Combination
34Drugs
35Female
36Filtration
37General aspects
38Glomerular Filtration Rate
39Heart failure
40Humans
41Hydrochlorothiazide - administration & dosage
42Hydrochlorothiazide - adverse effects
43Hypertension
44Hypertension - complications
45Hypertension - drug therapy
46Hypertension - physiopathology
47Internal Medicine
48Kidney
49Kidney diseases
50Kidney Failure, Chronic - complications
51Kidney Failure, Chronic - physiopathology
52Kidney Failure, Chronic - urine
53Male
54Medical sciences
55Methods
56Middle Aged
57Mortality
58Patient outcomes
59Risk Factors
60secondary analysis
61Side effects
62Studies
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eissn1474-547X
codenLANCAO
abstractSummary Background The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial showed that initial antihypertensive therapy with benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascular morbidity and mortality. We assessed the effects of these drug combinations on progression of chronic kidney disease. Methods ACCOMPLISH was a double-blind, randomised trial undertaken in five countries (USA, Sweden, Norway, Denmark, and Finland). 11 506 patients with hypertension who were at high risk for cardiovascular events were randomly assigned via a central, telephone-based interactive voice response system in a 1:1 ratio to receive benazepril (20 mg) plus amlodipine (5 mg; n=5744) or benazepril (20 mg) plus hydrochlorothiazide (12·5 mg; n=5762), orally once daily. Drug doses were force-titrated for patients to attain recommended blood pressure goals. Progression of chronic kidney disease, a prespecified endpoint, was defined as doubling of serum creatinine concentration or end-stage renal disease (estimated glomerular filtration rate <15 mL/min/1·73 m2 or need for dialysis). Analysis was by intention to treat (ITT). This trial is registered with ClinicalTrials.gov , number NCT00170950. Findings The trial was terminated early (mean follow-up 2·9 years [SD 0·4]) because of superior efficacy of benazepril plus amlodipine compared with benazepril plus hydrochlorothiazide. At trial completion, vital status was not known for 143 (1%) patients who were lost to follow-up (benazepril plus amlodipine, n=70; benazepril plus hydrochlorothiazide, n=73). All randomised patients were included in the ITT analysis. There were 113 (2·0%) events of chronic kidney disease progression in the benazepril plus amlodipine group compared with 215 (3·7%) in the benazepril plus hydrochlorothiazide group (HR 0·52, 0·41–0·65, p<0·0001). The most frequent adverse event in patients with chronic kidney disease was peripheral oedema (benazepril plus amlodipine, 189 of 561, 33·7%; benazepril plus hydrochlorothiazide, 85 of 532, 16·0%). In patients with chronic kidney disease, angio-oedema was more frequent in the benazepril plus amlodipine group than in the benazepril plus hydrochlorothiazide group. In patients without chronic kidney disease, dizziness, hypokalaemia, and hypotension were more frequent in the benazepril plus hydrochlorothiazide group than in the benazepril plus amlodipine group. Interpretation Initial antihypertensive treatment with benazepril plus amlodipine should be considered in preference to benazepril plus hydrochlorothiazide since it slows progression of nephropathy to a greater extent. Funding Novartis.
copKidlington
pubElsevier Ltd
pmid20170948
doi10.1016/S0140-6736(09)62100-0