Exceptional early blood pressure control rates: The ACCOMPLISH trial

Figures & data

Table I. Effects of initial combination therapy on systolic blood pressure at 6 months in ACCOMPLISH.

Patient groups	Baseline (on pre‐study medication)			6 months (combination therapy)
	n	Mean	SD	Mean	SD	Mean change^a	SD
All	10,704	145.5	18.2	132.5	16.0	−13.03	18.2
USA	7415	142.3	17.3	130.2	15.3	−12.14	17.7
Nordic	3289	152.6	18.2	137.6	16.5	−15.03	19.0
Male	6576	145.2	18.0	132.3	15.7	−12.97	17.7
Female	4128	145.9	18.6	132.8	16.6	−13.12	18.8
Age ⩾70	4362	146.7	18.3	133.3	16.3	−13.43	18.9
Age <70	6342	144.7	18.1	131.9	15.8	−12.75	17.6
Caucasian	9074	145.7	18.2	132.4	16.0	−13.27	18.1
Black	1205	144.9	18.3	133.3	16.3	−11.65	18.3
Asian	44	139.2	15.2	126.2	12.0	−13.03	15.9
Other	381	143.6	18.7	132.2	16.6	−11.48	18.2
DM	6480	145.3	18.0	132.8	16.1	−12.48	17.7
CKD^b	1853	145.5	19.1	133.5	16.8	−12.00	19.1
CHD	4958	144.0	18.1	131.0	15.6	−13.19	18.2

^aMean change from baseline was significantly different (p<0.001) from zero at 6 months. DM, diabetes mellitus; CKD, chronic kidney disease; CHD, coronary heart disease. ^bCKD = glomerular filtration rate (GFR) ⩽60 cm³/min/1.73 m² calculated by Modification of Diet in Renal Disease (MDRD).

Figure 1 Change in distribution of systolic blood pressure(SBP) after 6 months of combination therapy in the ACCOMPLISH trial.

Table II. Effects of initial combination therapy on blood pressure control rates at 6 months in ACCOMPLISH.

Patient groups	n	Baseline rates	6 months^a
		% Controlled	% Controlled
All	10,704	37.2	73.2
USA	7415	44.4	78.3
Nordic	3289	21	61.8
Male	6576	36.9	73.6
Female	4128	37.7	72.6
Age ⩾70	4362	35.1	72
Age <70	6342	38.7	74
Caucasian	9074	36.6	73.4
Black	1205	38.8	70.8
Asian	44	50	90.9
Other	381	44.6	73.2
DM	6480	38	72.5^b
CKD^c	1853	37.9	70.8^b
CHD	4958	40	76.8

DM, diabetes mellitus; CKD, chronic kidney disease; CHD, coronary heart disease. ^aWithin‐group change from baseline was significant (p<0.01) at 6 months for all randomized patients and for all subgroups. Control defined as BP<140/90 mmHg. ^bControl rates of BP<130/80 mmHg were 43% in DM patients and 40% in CKD patients. ^cCKD = glomerular filtration rate (GFR)⩽60 cm³/min/1.73 m² calculated by Modification of Diet in Renal Disease (MDRD).

Figure 2 Distribution of study medications and dose titration during 6 months of ACCOMPLISH trial.

Table III. Most frequent adverse events at 6 months in ACCOMPLISH (>1%).

Adverse event (AE)	n	%
Total patients with AE	6637	58.3
Dizziness	2144	18.8
Cough	2026	17.8
Edema peripheral	2009	17.6
Hypotension	207	1.8
Chest pain	159	1.4
Fatigue	163	1.4
Atrial fibrillation	143	1.3
Congestive cardiac failure	130	1.1

Table IV. Achieved blood pressure in recent multi‐center clinical trials.

Trial	Baseline BP (mmHg)	Final BP (mmHg)
HOT	175/105	142/83
CAPPP	161/99	150/90
STOP‐2	194/88	159/81
NORDIL	173/106	151/88
INSIGHT	173/99	138/82
LIFE	174/98	145/81
ALLHAT	145/83	136/76
VALUE	154/88	138/79
ASCOT‐LLA	164/95	138/80
ASCOT‐BPLA	164/95	137/78
ACCOMPLISH	145/80	132/74

BP, blood pressure; HOT, Hypertension Optimal Treatment Trial [15]; CAPPP, Captopril Prevention Project [16]; STOP‐2, The Swedish Trial in Old Patients with Hypertension‐2 [17]; NORDIL, Nordic Diltiazem [18]; INSIGHT, Intervention as a Goal in Hypertension Treatment [19]; LIFE, Losartan Intervention for Endpoint Reduction in Hypertension Study [20]; ALLHAT, The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial [6], [21]; VALUE, Valsartan Antihypertensive Long‐term Use Evaluation Trial of Cardiovascular Events in Hypertension [8], [22]; ASCOT‐LLA, Anglo‐Scandinavian Cardiac Outcomes Trial – Lipid‐Lowering Arm [23]; ASCOT‐BPLA, Anglo‐Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm [13]; ACCOMPLISH, Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension.

Hansson L., Zanchetti A., Carruthers S. G., Dahlof B., Elmfeldt D., Julius S., et al. for the HOT Study Group. Effects of intensive blood‐pressure lowering and low‐dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351: 1755–1762

 PubMed Web of Science ®Google Scholar

Hansson L., Lindholm L. H., Niskanen L., Lanke J., Hedner T., Nikalson A., et al. for the Captopril Prevention Project (CAPPP) study group. Effect of angiotensin‐converting enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: The Captopril Prevention Project (CAPPP) randomized trial. Lancet 1999; 353: 611–616

 PubMed Web of Science ®Google Scholar

Hansson L., Lindholm L. H., Ekbom T., Dahlof B., Lanke J., Schersten B., et al. for the STOP‐Hypertension‐2 study group. Randomized trial of old and new antihypertensive drugs in elderly patients: Cardiovascular mortality and morbidity, the Swedish Trial in Old Patients with Hypertension‐2 study. Lancet 1999; 354: 1751–1756

 PubMed Web of Science ®Google Scholar

Hansson L., Hedner T. M., Lund‐Johansen P., Kjeldsen S. E., Lindholm L. H., Syvertsen J. O., et al. for the NORDIL Study Group. Randomized trial effects of calcium antagonists compared with diuretics and (‐blockers on cardiovascular morbidity and mortality in hypertension: The Nordic Diltiazem (NORDIL) study. Lancet 2000; 356: 359–365

 PubMed Web of Science ®Google Scholar

Brown M. J., Palmer C. R., Castaigne A., de Leeuw P. W., Mancia G., Rosenthal T., et al. Morbidity and mortality in patients randomized to double‐blind treatment with a long‐acting calcium‐channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 2000; 356: 366–372

 PubMed Web of Science ®Google Scholar

Dahlöf B., Devereux R. B., Kjeldsen S. E., Julius S., Beevers G., de Faire U., et al. for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomized trial against atenolol. Lancet 2002; 359: 995–1003

 PubMed Web of Science ®Google Scholar

The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high‐risk hypertensive patients randomized to angiotensin‐converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–2997

 PubMed Web of Science ®Google Scholar

Cushman W. C., Ford C. E., Cutler J. A., Margolis K. L., Davis B. R., Grimm R. H., et al. for the ALLHAT Research Group. Success and predictors of blood pressure control in diverse North American settings: The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2002; 4: 393–404

 PubMedGoogle Scholar

Julius S., Kjeldsen S., Weber M., Brunner H. R., Ekman S., Hansson L., et al. for the VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: The VALUE randomized trial. Lancet 2004; 363: 2022–2031

 PubMed Web of Science ®Google Scholar

Weber M. A., Julius S., Kjeldsen S. E., Brunner H. R., Ekman S., Hansson L., et al. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE trial. Lancet 2004; 363: 2049–2051

 PubMed Web of Science ®Google Scholar

Sever P. S., Dahlöf B., Poulter N. R., Wedel H., Beevers G., Caulfield M., et al. for the ASCOT Investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower‐than‐average cholesterol concentrations, in the Angio‐Scandinavian Cardiac Outcomes Trial–Lipid lowering Arm (ASCOT‐LLA): A multicentre randomized controlled trial. Lancet 2003; 361: 1149–1158

 PubMed Web of Science ®Google Scholar

Dahlöf B., Sever P. S., Poulter N. R., Wedel H., Beevers D. G., Caulfield M., et al. for the ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo‐Scandinavian Cardiac Outcomes Trial‐Blood Pressure Lowering Arm (ASCOT‐BPLA): A multicentre randomized controlled trial. Lancet 2005; 366: 895–906

 PubMed Web of Science ®Google Scholar