Fine-tuning hypertension therapies in patients with diabetes

January 01, 0001

Fine-tuning hypertension therapies in patients with diabetes

The aim of this study was to determine which combination therapy in patients with hypertension and diabetes most effectively decreases cardiovascular events. 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. 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.

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 (HR significant). For the diabetic patients at very high risk, there were 195 (13.6%) and 244 (17.3%) primary events (HR 0.77, significant). In the nondiabetic patients, there were 245 (10.8%) and 296 (12.9%) primary events (HR 0.82, significant). In the diabetic patients, there were clear coronary benefits with B+A, including both acute clinical events (significant) and revascularizations (significant). There were no unexpected adverse events.

The researchers concluded: "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."

Part of the fine-tuning of medicine allowed with evidence.

For the full abstract, click here.

J Am Coll Cardiol 56(1):77-85, 29 June 2010
© 2010 by the American College of Cardiology Foundation
Cardiovascular Events During Differing Hypertension Therapies in Patients With Diabetes. Michael A. Weber, George L. Bakris, Kenneth Jamerson et al for the ACCOMPLISH Investigators. Correspondence to Dr Michael Weber: [email protected]

Category: K. Circulatory. Keywords: amlodipine, coronary events, diabetes, hydrochlorothiazide, hypertension, comparative study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 6 August 2010

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