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Cardiovascular events during differing hypertension therapies in patients with diabetes.

Abstract：

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).

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Weber MA,Bakris GL,Jamerson K,Weir M,Kjeldsen SE,Devereux RB,Velazquez EJ,Dahlöf B,Kelly RY,Hua TA,Hester A,Pitt B,ACCOMPLISH Investigators.

doi

10.1016/j.jacc.2010.02.046

subject

Has Abstract

pub_date

2010-06-29 00:00:00

pages

77-85

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(10)01523-8

journal_volume

pub_type

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Cardiovascular events during differing hypertension therapies in patients with diabetes.