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Randomized, double-blind active-control 10,462 high CV-risk hypertensive patients age 55+ yrs

Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH): Design. Randomized, double-blind active-control 10,462 high CV-risk hypertensive patients age 55+ yrs No history of symptomatic HF or evidence of LVEF<40%

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Randomized, double-blind active-control 10,462 high CV-risk hypertensive patients age 55+ yrs

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  1. Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH): Design • Randomized, double-blind active-control • 10,462 high CV-risk hypertensive patients age 55+ yrs • No history of symptomatic HF or evidence of LVEF<40% • Two fixed-dose antihypertensive combinations • HCTZ/benazepril (12.5-25/40 mg [ ACE force-titrated]) • Amlodipine/benazepril (5-10/40 mg [ACE force-titrated]) • Primary endpoint: CV mortality & morbidity • Morbidity: MI, stroke, hospitalized unstable angina, resuscitated sudden cardiac death, coronary revascularization • Mortality: sudden cardiac death, MI, stroke, coronary intervention, heart failure, other CV causes 8/20/2008 Jamerson KA et al., Am J Hypertens 2004;17:793-801

  2. ACCOMPLISH Preliminary Results:Primary* and Secondary End Points Jamerson KA, et al. March 31, 2008; Chicago, IL. http://www.theheart.org/article/852911.do 8/20/2008

  3. Perspective • May be promoted by some to encourage use of CCBs over thiazide-type diuretics (each with RAS inhibitors). • Calls for guidelines changes are premature. • Dose of thiazide-type diuretic – • Doses of thiazide-type diuretics equivalent to <25-50 mg/day HCTZ have not been evaluated in clinical outcome trials demonstrating the benefits of HCTZ on CVD outcomes • Data on HF not provided for ACCOMPLISH • In ALLHAT, adequate dosage of diuretic was superior to both the CCB and ACE-inhibitor in preventing HF and unsurpassed for other CVD-renal outcomes 8/20/2008

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