title: Predictors of systolic BP <140 mmHg and systolic BP level by randomly assigned treatment group (benazepril plus amlodipine or hydrochlorothiazide) in the ACCOMPLISH Study.
abstract: BACKGROUND
  The ACCOMPLISH Trial investigated intensive antihypertensive combination treatment with benazepril + amlodipine (B+A) or benazepril + hydrochlorothiazide (B+H) on cardiovascular outcomes in patients with systolic hypertension. We analyzed the baseline predictors of achieving a systolic blood pressure (SBP) <140 mmHg and achieved SBP level by the end of 12 months in both treatment groups.
  
  
  METHODS
  Baseline and 12-month SBP was available in 10,506 patients, of whom 6250 had diabetes. Univariate and multivariate logistic regression models were used for SBP control at 12 months and multivariable regression models were used for the prediction of SBP at 12 months. A stepwise procedure was used to select significant (p < 0.001) predictors in multivariate analyses.
  
  
  RESULTS
  Mean (± SD) BP fell from 145.4/80.1 (± 18.3/10.7) mmHg at randomization to 132.8/74.7 (± 16.0/9.6) mmHg at 12 months. The main baseline predictors of SBP control <140 mmHg were region (USA >Nordic region) and Caucasian ethnicity in both randomization arms. A higher diastolic BP and the use of lipid lowering agents indicated favorable effects in the B+H arm only. The predictors of uncontrolled SBP were: (i) higher baseline SBP values, (ii) higher number of previous antihypertensive medications in both arms, (iii) the previous use of insulin in the B+A arm, and (iv) pre-trial calcium channel blocker (CCB) use in the B+H arm. Additionally, pre-trial use of thiazides and electrocardiogram (ECG)-left ventricular hypertrophy (LVH) at baseline predicted higher, and smoking lower absolute SBP in the B+A arm and the use of thiazides and proteinuria a higher SBP in the B+H arm.
  
  
  CONCLUSIONS
  Irrespective of treatment, patients in the USA and Caucasians achieved better SBP control, whereas higher baseline SBP and more previous antihypertensive medications indicated less control. Concomitant use of lipid lowering treatment indicated a better SBP control in the benazepril + hydrochlorothiazide arm. Lastly, insulin use and ECG-LVH in the benazepril + amlodipine arm and proteinuria in the benazepril + hydrochlorothiazide arm indicated poor control.
authors.affiliation: University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Jamerson
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
authors.forename: Roxzana Y
authors.initials: RY
authors.lastname: Kelly
authors.forename: Dion
authors.initials: D
authors.lastname: Zappe
authors.forename: Allen
authors.initials: A
authors.lastname: Hester
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: Jan
authors.initials: J
authors.lastname: Ostergren
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
mesh_terms: D017311:Amlodipine / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001552:Benzazepines / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D013599:Systole / Q000187:drug effects*
chemical_list: D000959:Antihypertensive Agents; D001552:Benzazepines; D006852:Hydrochlorothiazide; D017311:Amlodipine; C044946:benazepril