Predictors of blood pressure response to intensified and fixed combination treatment of hypertension: the ACCOMPLISH study.
BACKGROUND
Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH) is an outcome study investigating aggressive antihypertensive combination treatment. It has achieved a larger fraction of overall patients with blood pressure (BP) <140/90 mmHg (73.3%) and diabetic patients <130/80 mmHg (43.3%) at 12 months of follow-up than any other large outcomes trial. We have analyzed baseline predictors of BPs and BP control at 12 months.


METHODS
Blinded baseline and 12-month BP was available in 10,173 patients of whom 6132 had diabetes. Univariate and multivariate logistic regression models were used for BP control at 12 months; simple and multiple regression models were used for absolute BP value at 12 months. A stepwise procedure was used to select significant predictors in multivariate analyses.


RESULTS
Mean (SD) BP fell from 145.5/80.2 mmHg (18.2/10.7 mmHg) at randomization to 132.7/74.7 mmHg (16/9.6 mmHg) at 12 months. The main baseline predictors of achieving BP control were region (USA), Caucasian race and taking lipid-lowering drugs. The predictors of uncontrolled BP were higher baseline systolic BP values, more previous antihypertensive medications, proteinuria and previous thiazide use.


CONCLUSIONS
Patients in the USA, Caucasians and patients taking lipid-lowering therapy were most likely to reach BP targets with combination therapy. Strong predictors of uncontrolled hypertension were more severe hypertension, an established need for more antihypertensive drugs and target organ damage.
Kjeldsen
Sverre E
SE
University of Michigan Health System, Ann Arbor, Michigan, USA.
Jamerson
Kenneth A
KA
Bakris
George L
GL
Pitt
Bertram
B
Dahlöf
Björn
B
Velazquez
Eric J
EJ
Gupte
Jitendra
J
Staikos
Linda
L
Hua
Tsushung A
TA
Shi
Victor
V
Hester
Allen
A
Tuomilehto
Jaakko
J
Ostergren
Jan
J
Ibsen
Hans
H
Weber
Michael
M
D000368:Aged; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005387:Finland; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D044469:Racial Groups / Q000706:statistics & numerical data; D018570:Risk Assessment; D012537:Scandinavian and Nordic Countries; D016896:Treatment Outcome; D014481:United States
D000959:Antihypertensive Agents; D001552:Benzazepines; D006852:Hydrochlorothiazide; D017311:Amlodipine; C044946:benazepril