Abstract
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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