Exceptional early blood pressure control rates: the ACCOMPLISH trial.
Jamerson K,
Bakris GL,
Dahlöf B,
Pitt B,
Velazquez E,
Gupte J,
Lefkowitz M,
Hester A,
Shi V,
Kjeldsen SE,
Cushman W,
Papademetriou V,
Weber M;
ACCOMPLISH Investigators.
University of Michigan Health System, Division of Cardiovascular Medicine, Ann Arbor, Michigan 48106-0739, USA. jamerson@umich.edu
BACKGROUND: ACCOMPLISH is a "new-generation" hypertension trial assessing single-tablet combination therapy for initial treatment of high-risk hypertension. At baseline, 97% of subjects were treated with anti-hypertensive medication at entry, but only 37% of participants had blood pressure (BP) control (<140/90 mmHg). Single-tablet combination therapy may improve control rates. METHODS: The mean BP change from baseline at the end of 6 months (the time point when subjects should have had all of the drug titrations to achieve BP control) was examined for 10,704 randomized patients. Within-group changes were examined using t-tests. Comparisons between subgroups were made using analysis of variance (ANOVA) and covariance (ANCOVA). RESULTS: Mean (+/-SD) BP fell from 145+/-18/80+/-11 mmHg at randomization to 132+/-16/74+/-10 mmHg. The 6-month BP control rate was 73% in the overall trial (78% in the US), 43% in diabetics and 40% in patients with renal disease. Of the patients uncontrolled, 61% were not on maximal medications, suggesting potential increases in control rates. Serious hypotensive events occurred in 1.8% of participants. CONCLUSION: ACCOMPLISH BP control rates are the highest of any multi-national trial to date. Whereas current guidelines recommend combination therapy only for stage 2 hypertension, in this trial it is expedient and safe for both stage 1 and 2 hypertension.
PMID: 17612905 [PubMed - indexed for MEDLINE]