Tuesday, December 16, 2008

What did Lotrel ACCOMPLISH?

Blood pressure is a 'surrogate marker.' This vital sign is easily obtained at home, at the grocery, and in the doctor's office, and the success with which any antihypertensive medication lowers the BP is correlated with the final desirable outcome of blood pressure therapy, namely decreasing the risk of heart attack, stroke, and death by cardiovascular disease. In order to best accomplish our goal of avoiding those pesky outcomes, large studies have been undertaken to see which BP meds work best.

The Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension or ACCOMPLISH trial compared the effects of two combination therapies on cardiovascular events in thousands of hypertensive patients over the age of 55. These subjects were already hypertensive, many were on more than two medications, and only a third of them or so had their blood pressure within the therapeutic goal of less than 140/90. All of them had some sort of health trouble which significantly increased their risk of future problems, including a history of stroke, heart attack, diabetes, enlarged heart, decreased blood flow to their legs, or kidney disease.

They discontinued their current meds; half began Lotrel which is a combination of Lotensin (aka benazepril) and Norvasc (aka amlodopine) and the other half started benazepril plus a water pill known as hydrochlorothiazide (HCTZ). HCTZ has been considered first-line therapy for high blood pressure.

But ACCOMPLISH became one of those 'stop the study' studies by the end of three years. In other words, the benefits of the Lotrel combo were so compelling with respect to preventing unwanted cardiovascular death and disease--decreasing risk of same by 20% compared to conventional therapy--that the researchers called off the trial in order that everyone might benefit from the now proven superior approach.

So take that HCTZ at least when it comes to treating a high risk population. Here's what Dr. Franz Messerli had to say:

This landmark study unequivocally relegates hydrochlorothiazide from first-line to third-line therapy at least in a patient population with similar demographic and clinical features as in ACCOMPLISH. The issue is not to be taken lightly, since hydrochlorothiazide remains one of the most commonly prescribed antihypertensive drugs. Every year more than 100 million prescriptions of hydrochlorothiazide are written in the US. Almost half of those prescriptions are written for hydrochlorothiazide alone.

Some persons don't tolerate Lotrel very well, suffering a cough from the Lotensin part or swelling from the amlodopine component. Lotrel is available in some strengths as a generic, though it is thus far one of those pricey generics.

1 comment:

Mauigirl said...

Hmmm. I'm on Diovan and hydrochlorothiazide. It works for me; BP is normal now.

The problem with studies like this is they are only comparing two specific combinations. I wonder what would happen if they compared, say, 10 different combinations.