Exceptional early blood pressure control rates: The ACCOMPLISH trial
Open accessAbstract
BACKGROUND: ACCOMPLISH is a "new-generation" hypertension trial assessing single-tablet combination therapy for initial treatment of high-risk hypertension. At baseline, 97% of subjects were treated with anti-hypertensive medication at entry, but only 37% of participants had blood pressure (BP) control (<140/90 mmHg). Single-tablet combination therapy may improve control rates. METHODS: The mean BP change from baseline at the end of 6 months (the time point when subjects should have had all of the drug titrations to achieve BP control) was examined for 10,704 randomized patients. Within-group changes were examined using t-tests. Comparisons between subgroups were made using analysis of variance (ANOVA) and covariance (ANCOVA). RESULTS: Mean (+/-SD) BP fell from 145+/-18/80+/-11 mmHg at randomization to 132+/-16/74+/-10 mmHg. The 6-month BP control rate was 73% in the overall trial (78% in the US), 43% in diabetics and 40% in patients with renal disease. Of the patients uncontrolled, 61% were not on maximal medications, suggesting potential increases in control rates. Serious hypotensive events occurred in 1.8% of participants. CONCLUSION: ACCOMPLISH BP control rates are the highest of any multi-national trial to date. Whereas current guidelines recommend combination therapy only for stage 2 hypertension, in this trial it is expedient and safe for both stage 1 and 2 hypertension.
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The higher prevalence of apparent treatment-resistant hypertension among treated hypertensive adults in clinical trials (34%-39%) is likely explained by the selection of patients with demographic and comorbidity characteristics that place them at high risk for the fatal and nonfatal cardiovascular disease outcomes of interest.
“The higher prevalence of aTRH among treated hypertensive adults in clinical trials (34%−39%) is likely explained by the selection of patients with demographic and comorbidity characteristics that place them at high risk for the fatal and nonfatal CVD outcomes of interest.21–26”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [25]
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Combining RAAS and calcium channel blockade: ACCOMPLISH in perspective
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Self-citationAntihypertensive and organ-protective effects of benazepril
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Optimizing Management of Hypertension With Combination Therapy
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Stagnant Cardiovascular Prevention: Alarming Trends and Persistent Socioeconomic Hurdles
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Factores modificables de riesgo cardiovascular: ¿Cuáles estamos realmente modificando?
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- Authors
- Jamerson, K., Bakris, G. L., Dahlöf, B., Pitt, B., Velazquez, E., Gupte, J., Lefkowitz, M., Hester, A., Shi, V., Kjeldsen, S. E., Cushman, W., Papademetriou, V., Weber, M., Jamerson, K., Bakris, G. L., Dahlöf, B., Pitt, B., Velazquez, E., Gupte, J., Lefkowitz, M., Hester, A., Shi, V., Kjeldsen, S. E., Cushman, W., Papademetriou, V., & Weber, M.
- Venue
- Blood Pressure
- Publisher
- Informa UK Limited
- Published
- 2007-01
- Volume
- 16
- Issue
- 2
- Pages
- 80-86
- ISSN
- 0803-7051 (ISSN-L)
- 1651-1999
- OpenAlex
- W2074526141
- Cited by
- 125
- References
- 24
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 4 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 6 · 2016: 1 · 2015: 2 · 2014: 5 · 2013: 9 · 2012: 6
- FWCI
- 16.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Blood Pressure (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Brigham and Women's Hospital
- Novartis Pharma
- Duke Clinical Research Institute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- ACCOMPLISH trial, hypertension, blood pressure control, antihypertensive drugs, high-risk hypertension, diabetes mellitus, kidney disease, hypotension, dose titration
- MeSH terms
- Antihypertensive Agents, Benzazepines, Blood Pressure, Double-Blind Method, Drug Therapy, Combination, Humans, Hydrochlorothiazide, Hypertension, Amlodipine
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