A large clinical trial has demonstrated that combination treatment with benazepril and amlodipine reduces the risk of death by 20% compared to conventional therapy in high-risk patients with high blood pressure, according to an article published in the December 4, 2008 issue of the New England Journal of Medicine .

The optimal combination of medications for hypertension, or high blood pressure, has not yet been established. However, current US guidelines recommend inclusion of a diuretic (commonly referred to as a 'water pill'), such as hydrochlorothiazide, either alone or in combination with another medication. The ACCOMPLISH (Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension) trial was designed to evaluate the efficacy of two different types of combination antihypertensive therapy in reducing the rate of cardiovascular events (such as heart attack or stroke) in high-risk patients.

The ACCOMPLISH trial involved 11,506 men and women aged 55 years or older with high blood pressure and evidence of hypertension-related kidney or other organ damage. The participants were randomized to receive either benazepril plus amlodipine or benazepril plus hydrochlorothiazide, and they were followed for an average of 3 years. Although both treatment groups experienced good blood pressure control, the patients who were treated with benazepril plus amlodipine had a significantly reduced risk of death and non-fatal heart attack or stroke.

More than 100 million prescriptions for hydrochlorothiazide are written in the United States every year. Approximately half of these prescriptions for hydrochlorothiazide alone. The findings of the ACCOMPLISH trial suggest that, among high-risk patients with hypertension, a combination of benazepril plus amlodipine may be more effective than both single medication therapy and combination therapy with hydrochlorothiazide.

Source

N Engl J Med. 2008;359:2417-2428.