A fixed-dose combination of a calcium channel blocker (CCB) and an ACE inhibitor is not only more effective than a diuretic/ACE inhibitor combination in lowering blood pressure, but also reduces the relative risk of cardiovascular events by 20%. These are the conclusions of the ACCOMPLISH study, presented yesterday at the American College of Cardiology Annual Scientific Meeting in Chicago.

Ended ahead of schedule in October 2007, ACCOMPLISH is the first study to test the benefits of treatment with a single, fixed-dose combination tablet in high-risk patients with high blood pressure. The study randomised over 11,000 patients to two Novartis fixed-dose combinations: Lotrel (amlodipine/benazepril) and Lotensin HCT (hydrochlorothiazide/benazepril). The primary outcome was the combination of cardiovascular death, heart attack, stroke, unstable angina, revascularisation and resuscitation from death.

Presenting the results in Chicago, Dr Kenneth Jamerson, University of Michigan, USA, said that “ACCOMPLISH achieved "exceptional blood pressure control with combination therapy, and this offers a new option for patients taking antihypertensive medication who continue to be at risk. Our results provide compelling information that the combination of an ACE inhibitor and CCB should be initial therapy [for high blood pressure]".”

The results of ACCOMPLISH were always going to be a win-win for Novartis, but the study is also likely to have an important impact on clinical practice. At present, many patients do not achieve blood pressure targets when treated according to current guidelines, which recommend starting with one drug – often a diuretic – and gradually adding in others if necessary to achieve recommended blood pressure.

ACCOMPLISH shows the benefits of an alternative strategy, since around 80% of patients in both treatment groups achieved target blood pressure with a single fixed-dose tablet. At entry to the study, 74% of patients were taking two more blood pressure lowering drugs, but only 35.7% had reached recommended blood pressures. The study could also once and for all put to rest safety concerns that have dogged CCBs in the past, including risks of bleeding, cancer and dementia. By Sue Lyon in Chicago