ACE inhibitor–CCB combo benefits patients on tight BP control, with resistant hypertension

In the management of patients with high blood pressure (BP) or resistant hypertension, calcium channel blockers (CCB) confer a more favourable benefit than hydrochlorothiazide when added to an angiotensin converting enzyme (ACE) inhibitor, according to a posthoc analysis of the of the ACCOMPLISH trial.

ACCOMPLISH included 11,506 patients. The primary composite outcome for the current analysis was cardiovascular death, myocardial infarction, stroke, hospitalization for angina, resuscitation after sudden cardiac death, and coronary revascularization.

A total of 5,221 (45.4 percent) achieved a systolic blood pressure target of ≤130 mm Hg. In this group, the primary composite outcome occurred less frequently in the amlodipine/benazepril arm than in the hydrochlorothiazide/benazepril arm (9.2 percent vs 10.9 percent; adjusted hazard ratio [aHR], 0.83, 95 percent confidence interval [CI], 0.70–0.99).

Results in the group of patients with apparent resistant hypertension (defined as prescription of ≥4 antihypertensive medications; n=4,451) followed the same pattern. Fewer outcome events occurred with amlodipine/benazepril than with hydrochlorothiazide/benazepril (12.8 percent vs 15.2 percent; aHR, 0.81, 95 percent CI, 0.70–0.95).

When examined individually, most outcomes did not significantly differ between the treatment arm. But the trends favoured amlodipine/benazepril.

The findings add support that most patients, including those following the 2017 hypertension guidelines, will fare well with the CCB/ACE inhibitor combination.