title: Cardiovascular events during differing hypertension therapies in patients with diabetes.
abstract: OBJECTIVE
  The aim of this study was to determine which combination therapy in patients with hypertension and diabetes most effectively decreases cardiovascular events.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for angina, resuscitated arrest, and coronary revascularization.
  
  
  RESULTS
  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 (hazard ratio [HR]: 0.79, 95% confidence interval [CI]: 0.68 to 0.92, p = 0.003). For the diabetic patients at very high risk, there were 195 (13.6%) and 244 (17.3%) primary events (HR: 0.77, 95% CI: 0.64 to 0.93, p = 0.007). In the nondiabetic patients, there were 245 (10.8%) and 296 (12.9%) primary events (HR: 0.82, 95% CI: 0.69 to 0.97, p = 0.020). In the diabetic patients, there were clear coronary benefits with B+A, including both acute clinical events (p = 0.013) and revascularizations (p = 0.024). There were no unexpected adverse events.
  
  
  CONCLUSIONS
  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. (Avoiding Cardiovascular Events Through COMbination Therapy in Patients Living With Systolic Hypertension [ACCOMPLISH]; NCT00170950).
authors.affiliation: Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York 11203, USA. michaelwebermd@cs.com
authors.forename: Michael A
authors.initials: MA
authors.lastname: Weber
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.forename: Matthew
authors.initials: M
authors.lastname: Weir
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Roxzana Y
authors.initials: RY
authors.lastname: Kelly
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
authors.forename: Allen
authors.initials: A
authors.lastname: Hester
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage* / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001552:Benzazepines / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure; D003327:Coronary Disease / Q000517:prevention & control*; D048909:Diabetes Complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001552:Benzazepines; D006852:Hydrochlorothiazide; D017311:Amlodipine; C044946:benazepril