(February 18, 2010 - Insidermedicine)

The combination of benazepril plus amlodipine reduces the likelihood of progression of chronic kidney disease among high-risk hypertensive patients more than the combination of benazepril plus hydrochlorothiazide, according to a trial published online ahead of print in The Lancet.

Here is some information about treatment goals for hypertension, from the National Heart, Lung, and Blood Institute:

•    Since most persons with hypertension, especially those age >50 years, will reach the diastolic blood pressure goal once systolic blood pressure is at goal, the primary focus should be on achieving the systolic blood pressure goal.

•    Treating systolic and diastolic blood pressure to targets that are <140/90 mmHg is associated with a decrease in cardiovascular disease complications.

•    In patients with hypertension and diabetes or renal disease, the blood pressure goal is <130/80 mmHg.

Researchers out of the University of Chicago representing the ACCOMPLISH study investigators randomized 11,506 patients in five countries to receive either benazepril 20 mg plus amlodipine 5 mg or benazepril 20 mg plus hydrochlorothiazide 12.5 mg. All patients had hypertension and were at high risk for cardiovascular disease. The prespecified endpoint of progression to chronic kidney disease was defined as a doubling of serum creatinine concentration or end-stage renal disease.

The trial was terminated early, after a mean follow-up of 2.9 years, because of the superior efficacy of the benazepril/amlodipine treatment. Based on an intent-to-treat analysis, 2.0% of patients in this group experienced progression of chronic kidney disease, as compared with 3.7% in the other group.

Today’s research suggests that the combination of benazepril/amlodipine should be used in favor of benazepril/hydrochlorothiazide because of its superior renoprotective effects.