Fixed-dose combination with amlodypine/benazepril and chronic kidney disease – implications from the ACCOMPLISH trial Review article

Abstract

In the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial significant reduction in cardiovascular mortality and morbidity in population treated with benazepril plus amlodipine vs benazepril plus hydrochlorothiazide was observed. The authors of the study assessed also effects of these drug combinations on progression of chronic kidney disease. ACCOMPLISH was a double-blind, randomised trial. 11 506 high cardiovascular risk patients with hypertension were randomly assigned to receive benazepril (20 mg)/amlodipine (5 mg) or benazepril (20 mg)/hydrochlorothiazide (12,5 mg). Drug doses were force-titrated to achieve blood pressure goals. The primary endpoint was progression of chronic kidney disease, defined as doubling of serum creatinine concentration or end-stage renal disease (estimated glomerular filtration rate <15 ml/min/1,73 m² or need for dialysis). In this observation combined therapy with benazepril/amlodipine was superior to benazepril/ hydrochlorothiazide in the reduction of the progression of nephropathy (p <0,0001). Initial antihypertensive treatment with benazepril plus amlodipine should be considered in preference to benazepril plus hydrochlorothiazide since it slows much more effectively progression of chronic renal failure.