Cardiovascular Benefits of Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Patients Achieving Tight Blood Pressure Control and With Resistant Hypertension
© American Journal of Hypertension, Ltd 2020. All rights reserved. For Permissions, please email: journals.permissionsoup.com..
BACKGROUND: The 2017 hypertension guidelines lowered systolic blood pressure (BP) goals to <130 mm Hg and redefined resistant hypertension. We investigated if these changes alter the cardiovascular benefits demonstrated by combining a calcium channel blocker (CCB), rather than hydrochlorothiazide (HCTZ), with an angiotensin-converting enzyme inhibitor (ACEI).
METHODS: In this post hoc analysis of the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension trial (n = 11,506), we compared the primary composite outcome (cardiovascular death, myocardial infarction, stroke, hospitalization for angina, resuscitation after sudden cardiac death, and coronary revascularization) between the 2 combination-treatment limbs in patients achieving a systolic BP ≤130 mm Hg and those with "apparent resistant hypertension" (prescribed ≥4 antihypertensive medications).
RESULTS: Among study patients, 5,221 (45.4%) achieved a systolic BP ≤130 mm Hg. There were fewer primary endpoints in the amlodipine/benazepril (9.2%) vs. the HCTZ/benazepril (10.9%) limb (adjusted hazard ratio [HR] 0.83, 95% confidence interval [CI], 0.70-0.99). There were also fewer primary endpoints in the amlodipine/benazepril (12.8%) vs. the HCTZ/benazepril (15.2%) limb (n = 4,451, 38.7%) among patients with apparent resistant hypertension (HR 0.81, 95% CI, 0.70-0.95).
CONCLUSIONS: Combination therapy adding a CCB, rather than HCTZ, to an ACEI was more effective in preventing composite cardiovascular events even in hypertensive patients achieving aggressive systolic BP targets as well as in those with apparent resistant hypertension. Our findings add support that most patients, including those following contemporary clinical guidelines, will benefit from this combination.
CLINICAL TRIALS REGISTRATION: Trial Number NCT00170950.
| Errataetall: |
CommentIn: Am J Hypertens. 2021 May 22;34(5):459-462. - PMID 33558886 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:34 |
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| Enthalten in: |
American journal of hypertension - 34(2021), 5 vom: 22. Mai, Seite 531-539 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Brook, Robert D [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 09.12.2021 Date Revised 14.12.2021 published: Print ClinicalTrials.gov: NCT00170950 CommentIn: Am J Hypertens. 2021 May 22;34(5):459-462. - PMID 33558886 Citation Status MEDLINE |
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| doi: |
10.1093/ajh/hpaa192 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM317839306 |
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| 245 | 1 | 0 | |a Cardiovascular Benefits of Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Patients Achieving Tight Blood Pressure Control and With Resistant Hypertension |
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| 500 | |a Date Revised 14.12.2021 | ||
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| 500 | |a ClinicalTrials.gov: NCT00170950 | ||
| 500 | |a CommentIn: Am J Hypertens. 2021 May 22;34(5):459-462. - PMID 33558886 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © American Journal of Hypertension, Ltd 2020. All rights reserved. For Permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: The 2017 hypertension guidelines lowered systolic blood pressure (BP) goals to <130 mm Hg and redefined resistant hypertension. We investigated if these changes alter the cardiovascular benefits demonstrated by combining a calcium channel blocker (CCB), rather than hydrochlorothiazide (HCTZ), with an angiotensin-converting enzyme inhibitor (ACEI) | ||
| 520 | |a METHODS: In this post hoc analysis of the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension trial (n = 11,506), we compared the primary composite outcome (cardiovascular death, myocardial infarction, stroke, hospitalization for angina, resuscitation after sudden cardiac death, and coronary revascularization) between the 2 combination-treatment limbs in patients achieving a systolic BP ≤130 mm Hg and those with "apparent resistant hypertension" (prescribed ≥4 antihypertensive medications) | ||
| 520 | |a RESULTS: Among study patients, 5,221 (45.4%) achieved a systolic BP ≤130 mm Hg. There were fewer primary endpoints in the amlodipine/benazepril (9.2%) vs. the HCTZ/benazepril (10.9%) limb (adjusted hazard ratio [HR] 0.83, 95% confidence interval [CI], 0.70-0.99). There were also fewer primary endpoints in the amlodipine/benazepril (12.8%) vs. the HCTZ/benazepril (15.2%) limb (n = 4,451, 38.7%) among patients with apparent resistant hypertension (HR 0.81, 95% CI, 0.70-0.95) | ||
| 520 | |a CONCLUSIONS: Combination therapy adding a CCB, rather than HCTZ, to an ACEI was more effective in preventing composite cardiovascular events even in hypertensive patients achieving aggressive systolic BP targets as well as in those with apparent resistant hypertension. Our findings add support that most patients, including those following contemporary clinical guidelines, will benefit from this combination | ||
| 520 | |a CLINICAL TRIALS REGISTRATION: Trial Number NCT00170950 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a blood pressure | |
| 650 | 4 | |a blood pressure targets | |
| 650 | 4 | |a drug therapy | |
| 650 | 4 | |a hypertension | |
| 650 | 4 | |a prevention | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Antihypertensive Agents |2 NLM | |
| 650 | 7 | |a Calcium Channel Blockers |2 NLM | |
| 700 | 1 | |a Kaciroti, Niko |e verfasserin |4 aut | |
| 700 | 1 | |a Bakris, George |e verfasserin |4 aut | |
| 700 | 1 | |a Dahlöf, Björn |e verfasserin |4 aut | |
| 700 | 1 | |a Pitt, Bertrtam |e verfasserin |4 aut | |
| 700 | 1 | |a Velazquez, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Weber, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Jamerson, Kenneth A |e verfasserin |4 aut | |
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