Accomplish Update: Fixed Dose RAAS Blocker and CCB in Prevention of Endpoints in the Treatment of Hypertension Prof. Sverre E. Kjeldsen, MD, PhD Past-President European Society of Hypertension Department of Cardiology, Ullevaal University Hospital, Oslo, Norway, and Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A. The 4th International Conference FIXED COMBINATION, Paris, December 3, 2011
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Prof. Sverre E. Kjeldsen, MD, PhD Past-President European Society of Hypertension
The 4th International Conference FIXED COMBINATION, Paris, December 3, 2011. Accomplish Update: Fixed Dose RAAS Blocker and CCB in Prevention of Endpoints in the Treatment of Hypertension. Prof. Sverre E. Kjeldsen, MD, PhD Past-President European Society of Hypertension - PowerPoint PPT Presentation
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Accomplish Update: Fixed Dose RAAS Blocker and CCB in Prevention of Endpoints in the
Treatment of Hypertension
Prof. Sverre E. Kjeldsen, MD, PhDPast-President European Society of Hypertension
Department of Cardiology, Ullevaal University Hospital, Oslo, Norway, and
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A.
The 4th International Conference FIXED COMBINATION, Paris, December 3, 2011
Titrated to achieve BP<140/90 mmHg; <130/80 mmHg in patients with diabetes or renal insufficiency
Targeted Population for Recruitment into the Targeted Population for Recruitment into the ACCOMPLISH StudyACCOMPLISH Study
• Men or women age ≥ 55 years
• SBP ≥ 160 mmHg or currently on antihypertensive therapy
• Evidence of cardiovascular or renal disease or target organ damage
Accomplish randomized 3333 Nordic patients, 8067 American including 1361 African American patients, 6921 patients with diabetes (60%) and 680 patients with Chronic Renal Disease
Systolic Blood Pressure Over TimeSystolic Blood Pressure Over Timem
(Mean difference in 24 hour DBP = 0.3 mmHg, p=0.7)
ACCOMPLISH: Progression of chronic kidney disease (doubling of se-creatinine or ESRD) for the ITT population
Bakris GL et.al. Lancet 2010, Feb 18th
Changes in blood pressure throughout the trial in patients with chronic kidney disease
Bakris GL et.al. Lancet 2010, Feb 18th
N=680
Blood Pressure in Pts. With and Without Diabetes
Weber M, Bakris G, Kjeldsen SE et al. JACC 2010; 56: 77-85.
Weber M, Bakris G, Kjeldsen SE et al. JACC 2010; 56: 77-85.
Primary Event in Pts. With and Without Diabetes
Weber M, Bakris G, Kjeldsen SE et al. JACC 2010; 56: 77-85.
ACCOMPLISH Main Findings
• Fixed-dose forced titration of two drug combinations (ACEI/CCB or ACEI/HCTZ) achieved BP control in 80% of participants – the highest control rate ever seen in a large outcome trial in hypertension
• ACEI/CCB combination reduced primary CV endpoint by 20%
• The ambulatory BP substudy confirmed same BP control in ACEI/CCB and ACEI/HCTZ arms
• Treatment with ACEI/CCB reduced the secondary renal endpoint (doubling of se-creatinine or ESRD)
• Benefits of ACEI/CCB combination was homogenous through main subgroups of non-diabetics, diabetics and high-risk diabetics