Antihypertensive treatments can have various effects on progression of nephropathy

January 01, 0001

Antihypertensive treatments can have various effects on progression of nephropathy

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. The researchers from the USA and Greece assessed the effects of these drug combinations on progression of chronic kidney disease. 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. The trial was terminated early (mean follow-up 2·9 years) because of superior efficacy of benazepril plus amlodipine compared with benazepril plus hydrochlorothiazide.

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, significant). 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.

The researchers concluded: "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."

It is worth considering the effects of medications on co-morbidities and even though this study was limited to two different combinations, such information is welcome.

For the full abstract, click here.

The Lancet 375(9721):1173-1181, 3 April 2010 © Elsevier Ltd 2010
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. George L Bakris, Pantelis A Sarafidis, Matthew R Weir et al for the ACCOMPLISH Trial investigators. Correspondence to George L Bakris: [email protected]

Category: K. Circulatory. Keywords: renal, outcomes, combination therapies, hypertension, cardiovascular events, risk, secondary analysis of a randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 21 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.