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Brook RD, Kaciroti N, Bakris G, et al. Cardiovascular Benefits of Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Patients Achieving Tight Blood Pressure Control and With Resistant Hypertension. Am J Hypertens. 2021;34(5):531-539doi: 10.1093/ajh/hpaa192.
Brook, R. D., Kaciroti, N., Bakris, G., Dahlöf, B., Pitt, B., Velazquez, E., Weber, M. A., & Jamerson, K. A. (2021). Cardiovascular Benefits of Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Patients Achieving Tight Blood Pressure Control and With Resistant Hypertension. American journal of hypertension, 34(5), 531-539. https://doi.org/10.1093/ajh/hpaa192
Brook, Robert D, et al. "Cardiovascular Benefits of Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Patients Achieving Tight Blood Pressure Control and With Resistant Hypertension." American journal of hypertension vol. 34,5 (2021): 531-539. doi: https://doi.org/10.1093/ajh/hpaa192
Brook RD, Kaciroti N, Bakris G, Dahlöf B, Pitt B, Velazquez E, Weber MA, Jamerson KA. Cardiovascular Benefits of Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Patients Achieving Tight Blood Pressure Control and With Resistant Hypertension. Am J Hypertens. 2021 May 22;34(5):531-539. doi: 10.1093/ajh/hpaa192. PMID: 33216879.
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Am J Hypertens. 2021 May 22;34(5):531-539. doi: 10.1093/ajh/hpaa192.

Cardiovascular Benefits of Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Patients Achieving Tight Blood Pressure Control and With Resistant Hypertension.

American journal of hypertension

Robert D Brook, Niko Kaciroti, George Bakris, Björn Dahlöf, Bertrtam Pitt, Eric Velazquez, Michael A Weber, Kenneth A Jamerson

Affiliations

  1. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
  2. Center for Human Growth and Development and Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
  3. The University of Chicago Medicine, Chicago, Illinois, USA.
  4. Sahlgrenska University Hospital Östra, Göthenburg, Sweden.
  5. Duke University School of Medicine, Durham, North Carolina, USA.
  6. State University of New York Downstate, Brooklyn, New York, USA.

PMID: 33216879 DOI: 10.1093/ajh/hpaa192

Abstract

BACKGROUND: The 2017 hypertension guidelines lowered systolic blood pressure (BP) goals to <130 mm Hg and redefined resistant hypertension. We investigated if these changes alter the cardiovascular benefits demonstrated by combining a calcium channel blocker (CCB), rather than hydrochlorothiazide (HCTZ), with an angiotensin-converting enzyme inhibitor (ACEI).

METHODS: In this post hoc analysis of the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension trial (n = 11,506), we compared the primary composite outcome (cardiovascular death, myocardial infarction, stroke, hospitalization for angina, resuscitation after sudden cardiac death, and coronary revascularization) between the 2 combination-treatment limbs in patients achieving a systolic BP ≤130 mm Hg and those with "apparent resistant hypertension" (prescribed ≥4 antihypertensive medications).

RESULTS: Among study patients, 5,221 (45.4%) achieved a systolic BP ≤130 mm Hg. There were fewer primary endpoints in the amlodipine/benazepril (9.2%) vs. the HCTZ/benazepril (10.9%) limb (adjusted hazard ratio [HR] 0.83, 95% confidence interval [CI], 0.70-0.99). There were also fewer primary endpoints in the amlodipine/benazepril (12.8%) vs. the HCTZ/benazepril (15.2%) limb (n = 4,451, 38.7%) among patients with apparent resistant hypertension (HR 0.81, 95% CI, 0.70-0.95).

CONCLUSIONS: Combination therapy adding a CCB, rather than HCTZ, to an ACEI was more effective in preventing composite cardiovascular events even in hypertensive patients achieving aggressive systolic BP targets as well as in those with apparent resistant hypertension. Our findings add support that most patients, including those following contemporary clinical guidelines, will benefit from this combination.

CLINICAL TRIALS REGISTRATION: Trial Number NCT00170950.

© American Journal of Hypertension, Ltd 2020. All rights reserved. For Permissions, please email: [email protected].

Keywords: blood pressure; blood pressure targets; drug therapy; hypertension; prevention

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