Reductions in blood pressure and lipid parameters are generally lower than those previously projected , though substantial heterogeneity of results exists .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , single drug active component , or usual care but may be associated with improved adherence to a multidrug regimen .
BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of death and disability worldwide , yet CVD risk factor control and secondary prevention rates remain low .
A fixed-dose combination of blood pressure and cholesterol lowering and antiplatelet treatments into a single pill , or polypill , has been proposed as one strategy to reduce the global burden of CVD by up to 80 % given its potential for better adherence and lower costs .
OBJECTIVES To determine the effectiveness of fixed-dose combination therapy on reducing fatal and non-fatal CVD events and on improving blood pressure and lipid CVD risk factors for both primary and secondary prevention of CVD .
We also aim ed to determine discontinuation rates , adverse events , health-related quality of life , and costs of fixed-dose combination therapy .
Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial
BACKGROUND In previous clinical trials in high-risk hypertensive patients , paradoxically higher cardiovascular event rates have been reported in patients of normal weight compared with obese individuals . As a prespecified analysis of the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension ( ACCOMPLISH ) trial , we aim ed to investigate whether the type of hypertension treatment affects patients ' cardiovascular outcomes according to their body size . METHODS On the basis of body-mass index ( BMI ) , we divided the full ACCOMPLISH cohort into obese ( BMI ≥30 , n=5709 ) , overweight ( ≥25 to < 30 , n=4157 ) , or normal weight ( < 25 , n=1616 ) categories . The ACCOMPLISH cohort had already been r and omised to treatment with single-pill combinations of either benazepril and hydrochlorothiazide or benazepril and amlodipine . We compared event rates ( adjusted for age , sex , diabetes , previous cardiovascular events , stroke , or chronic kidney disease ) for the primary endpoint of cardiovascular death or non-fatal myocardial infa rct ion or stroke . The analysis was by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00170950 . FINDINGS In patients allocated benazepril and hydrochlorothiazide , the primary endpoint ( per 1000 patient-years ) was 30·7 in normal weight , 21·9 in overweight , and 18·2 in obese patients ( overall p=0·0034 ) . However , in those allocated benazepril and amlodipine , the primary endpoint did not differ between the three BMI groups ( 18·2 , 16·9 , and 16·5 , respectively ; overall p=0·9721 ) . In obese individuals , primary event rates were similar with both benazepril and hydrochlorothiazide and benazepril and amlodipine , but rates were significantly lower with benazepril and amlodipine in overweight patients ( hazard ratio 0·76 , 95 % CI 0·59 - 0·94 ; p=0·0369 ) and those of normal weight ( 0·57 , 0·39 - 0·84 ; p=0·0037 ) . INTERPRETATION Hypertension in normal weight and obese patients might be mediated by different mechanisms . Thiazide-based treatment gives less cardiovascular protection in normal weight than obese patients , but amlodipine-based therapy is equally effective across BMI subgroups and thus offers superior cardiovascular protection in non-obese hypertension . FUNDING Novartis Pharmaceuticals
Reductions in blood pressure and lipid parameters are generally lower than those previously projected , though substantial heterogeneity of results exists .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , single drug active component , or usual care but may be associated with improved adherence to a multidrug regimen .
BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of death and disability worldwide , yet CVD risk factor control and secondary prevention rates remain low .
A fixed-dose combination of blood pressure and cholesterol lowering and antiplatelet treatments into a single pill , or polypill , has been proposed as one strategy to reduce the global burden of CVD by up to 80 % given its potential for better adherence and lower costs .
OBJECTIVES To determine the effectiveness of fixed-dose combination therapy on reducing fatal and non-fatal CVD events and on improving blood pressure and lipid CVD risk factors for both primary and secondary prevention of CVD .
We also aim ed to determine discontinuation rates , adverse events , health-related quality of life , and costs of fixed-dose combination therapy .