ACE inhibitor plus calcium channel blocker safest

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Good

morning Sheila, welcome to the SearchMedica newsletter - 16 December 2008.

ACE inhibitor

plus calcium channel blocker safest

Combining

an ACE inhibitor

with a calcium channel

blocker more effectively reduces the

risk of cardiovascular

events than an ACE inhibitor with a diuretic,

a major new trial concludes.

The ACCOMPLISH study of more than 11,000 high risk hypertensive

patients was stopped early after finding the calcium channel blocker

combination clearly produced better outcomes and had fewer adverse events.

Researchers randomised patients to receive either benazepril plus

amlodipine or benazepril plus

hydrochlorothiazide, and followed them

up for an average of 30 months.

Mean blood pressure

in the calcium channel blocker group was 131.6/73.3 mmHg, compared with

132.5/74.7 mm Hg in the diuretic group. The calcium channel blocker

group also had fewer recorded adverse events, with a total of 552

(9.6%), compared with 679 (11.8%) with the diuretic.

Patients treated with an ACE inhibitor and a calcium channel blocker

were 21% less likely to suffer a cardiovascular

disease-related death or non-fatal heart

attack or stroke.

Current guidance from NICE

and the British

Hypertension Society recommends

combining a calcium channel blocker or a diuretic with an ACE inhibitor

as second-line

treatment of hypertension, but the best

combination has not been established.

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