Wednesday, April 2, 2008

Late-breaking clinical trial at ACC: Groundbreaking results from ACCOMPLISH
By Kelly Winget

A new study presented potentially clinical guideline-altering results for treating patients with hypertension.

Researchers found that using a dual treatment approach for patients with hypertension, one that includes a calcium-channel blocker, provides much better control of high blood pressure. The results from ACCOMPLISH were presented during a late-breaking clinical trial session at the American College of Cardiology 2008 Scientific Sessions. The DCRI's Eric Velazquez, MD, was one of the investigators on the trial.

ACCOMPLISH compared two types of combination treatments for hypertension and their impact on major fatal and nonfatal cardiovascular events. Researchers found that a single-tablet combination therapy with an ACE inhibitor plus a calcium-channel blocker lowered the risks of serious complications or death in high-risk patients with hypertension by 20 percent, compared to conventional treatment with a diuretic. The trial was stopped early because the calcium-channel blocker treatment was so much more effective than the conventional treatment.

ACE inhibitors dilate blood vessels to improve the amount of blood the heart can pump, which helps to lower blood pressure. Calcium-channel blockers are used to increase the supply of blood and oxygen to the heart while reducing the heart's workload.

Current guidelines for stage 1 hypertension first recommend treating patients with a diuretic with the possibility of an ACE inhibitor, calcium-channel blocker or beta blocker. For patients who have stage 2 hypertension, where their blood pressure is higher than 160/100 mm HG, the guidelines recommend a two-drug therapy, often with a diuretic and ACE inhibitor.

More than 11,000 men and women at least 55 years old were enrolled in the ACCOMPLISH trial. Patients either had systolic blood pressure greater than 160 mm HG or were currently on hypertension therapy and had evidence of cardiovascular or kidney disease. Many patients were obese and 60 percent had diabetes mellitus.

All patients were treated with a combination therapy, and either received an ACE inhibitor plus a calcium-channel blocker or an ACE inhibitor plus a diuretic. While more than 75 percent of patients in both groups lowered their blood pressure to the currently recommended target level, patients in the calcium-channel blocker group had significantly lower risk for heart attack, stroke, hospitalization for unstable angina and death.

Researchers said the findings challenge the current treatment guidelines and hope that physicians will begin reconsidering using a one-drug approach to treat hypertension in favor of combination therapy with calcium-channel blockers. Dr. Velazquez said the findings define a new standard for treating hypertension.