title: Exceptional early blood pressure control rates: the ACCOMPLISH trial.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Michigan Health System, Division of Cardiovascular Medicine, Ann Arbor, Michigan 48106-0739, USA. jamerson@umich.edu
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Eric
authors.initials: E
authors.lastname: Velazquez
authors.forename: Jitendra
authors.initials: J
authors.lastname: Gupte
authors.forename: Martin
authors.initials: M
authors.lastname: Lefkowitz
authors.forename: Allen
authors.initials: A
authors.lastname: Hester
authors.forename: Victor
authors.initials: V
authors.lastname: Shi
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: William
authors.initials: W
authors.lastname: Cushman
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
mesh_terms: D017311:Amlodipine / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001552:Benzazepines / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents; D001552:Benzazepines; D006852:Hydrochlorothiazide; D017311:Amlodipine; C044946:benazepril