高血圧のより良い治療

ACCOMPLISHスタディはアンジオテンシン変換酵素阻害薬とカルシウム拮抗薬が高血圧患者に対し有益性が大きいことが示された後、早期に終了された
ACCOMPLISH study ends early after angiotensin-converting enzyme inhibitor plus calcium channel blocker shows large benefits for patients with hypertension
アンジオテンシン変換酵素（ACE）阻害薬とカルシウム拮抗薬の併用は高血圧患者に対し非常に有効であったためphase IIIトライアルが早期に終了された、とのLate-Breaking Clinical Trialの結果がAmerican College of Cardiology学会で発表された。ACCOMPLISHスタディでは10,700人の患者をベナゼプリルとアムロジピン併用またはベナゼプリルとヒドロクロロチアジド併用群に無作為に割り付けた。対象患者の3分の2はスタディに組み込まれる前の治療では良好な血圧コントロールが得られなかったが、両併用治療ともに高血圧および他の心血管危険因子を有する患者の推奨血圧値を達成するのに有用であった。最も重要なことに、ACE阻害薬／カルシウム拮抗薬を併用した患者は他の併用療法を受けた群と比較し、心血管死、心筋梗塞、脳卒中、不安定狭心症による入院および血行再建術施行率を含む心臓関連イベントが20%少なかった。
Full Text

Combined therapy with an angiotensin-converting enzyme inhibitor plus a calcium channel blocker was so effective for patients with hypertension that a phase III trial was ended early, according to a late-breaking clinical trial presented at the annual meeting of the American College of Cardiology.

The international ACCOMPLISH study (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) compared two single-pill combinations of two medications: either an angiotensin-converting enzyme inhibitor and calcium channel blocker or an enzyme inhibitor and diuretic.

The randomized study of 10,700 adults showed that both drug combinations helped people who had hypertension and other cardiovascular risk factors recommended blood pressure levels despite the fact that two thirds of participants had been unable to achieve good blood pressure control with other medications prior to enrollment in the study.

Most importantly, the study revealed that patients taking the enzyme inhibitor/channel blocker combination had 20 percent fewer cardiac-related events than patients taking the other combination. Those events included cardiovascular deaths, myocardial infarctions, strokes, hospitalizations for unstable angina and revascularization procedures
One treatment arm received benazepril plus amlodipine, whereas the other pill combined benazepril and hydrochlorothiazide.

"These results demonstrate the superiority of an angiotensin-converting enzyme inhibitor/calcium channel blocker pill fixed-dose combination treatment strategy for reducing cardiovascular morbidity and mortality, and provides evidence that should modify future guidelines for the treatment of hypertension," says Kenneth Jamerson, M.D., the leader of ACCOMPLISH. Jamerson is a professor of internal medicine at the University of Michigan Medical School and a member of the Cardiovascular Center.

Results from the ACCOMPLISH trial show that just six months of treatment with either drug combination was enough to bring the blood pressure of 73 percent of patients into an acceptable range. However, by the end of the trial blood pressure control rates were 80 percent, with mean systolic blood pressure less than 130 mm Hg. This represents exceptional blood pressure control when contrasted to the current control rate of approximately 30 percent in the United States.

All patients in the study received no more than 40 milligrams of benazepril in each dose; amlodipine doses began at 5 mg and could be increased to 10 mg, while hydrochlorothiazide doses began at 12.5 mg and could be increased to 25 mg.

"These ACCOMPLISH results shake the foundations of current recommendations and define a new standard which will enhance the achievement of the primary goal and assist clinicians in meeting the daily challenges of hypertension management," said ACCOMPLISH executive committee member Eric J. Velazquez, MD, an Associate Professor of Medicine at Duke University Medical Center.