Benazepril-Amlodipine Reduces Cardiovascular Risk in High-Risk Patients

For high-risk patients with hypertension, benazepril plus amlodipine offers greater protection against cardiovascular events than benazepril-hydrochlorothiazide—despite similar effects on blood pressure, according to a report in The New England Journal of Medicine.

The industry-funded ACCOMPLISH trial included 11,506 patients with hypertension with a history of or risk factors for cardiovascular events. One group received the angiotensin-converting enzyme inhibitor benazepril plus the calcium-channel blocker amlodipine. The other group received benazepril plus the thiazide diuretic hydrochlorothiazide. Patients were followed up for a composite endpoint of cardiovascular death, nonfatal myocardial infarction or stroke, hospitalization for angina, resuscitation after sudden cardiac arrest, and coronary revascularization.

The study was stopped early after 36 months. There was no more than a 1 mm Hg difference in systolic blood pressure between groups. However, the primary outcome rate was 9.6 percent with benazepril-amlodipine versus 11.8 percent with benazepril-hydrochlorothiazide, with a hazard ratio of 0.80. The benazepril-amlodipine group had a similar reduction in a composite endpoint of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.

The results add to the evidence that benazepril-amlodipine combination can protect against end-organ damage, independent of the effect on blood pressure. “[O]ur findings may increase the options for combination treatment to reduce the risk of cardiovascular events among patients with hypertension,” the ACCOMPLISH investigators concluded [Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, and Velazquez EJ, for the ACCOMPLISH Trial Investigators: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359:2417–2428].