Jamerson Kenneth, Bakris George L, Dahlöf Björn, Pitt Bertram, Velazquez Eric, Gupte Jitendra, Lefkowitz Martin, Hester Allen, Shi Victor, Kjeldsen Sverre E, Cushman William, Papademetriou Vasilios, Weber Michael
University of Michigan Health System, Division of Cardiovascular Medicine, Ann Arbor, Michigan 48106-0739, USA.
Blood Press. 2007;16(2):80-6. doi: 10.1080/08037050701395571.
ACCOMPLISH is a "new-generation" hypertension trial assessing single-tablet combination therapy for initial treatment of high-risk hypertension. At baseline, 97% of subjects were treated with anti-hypertensive medication at entry, but only 37% of participants had blood pressure (BP) control (<140/90 mmHg). Single-tablet combination therapy may improve control rates.
The mean BP change from baseline at the end of 6 months (the time point when subjects should have had all of the drug titrations to achieve BP control) was examined for 10,704 randomized patients. Within-group changes were examined using t-tests. Comparisons between subgroups were made using analysis of variance (ANOVA) and covariance (ANCOVA).
Mean (+/-SD) BP fell from 145+/-18/80+/-11 mmHg at randomization to 132+/-16/74+/-10 mmHg. The 6-month BP control rate was 73% in the overall trial (78% in the US), 43% in diabetics and 40% in patients with renal disease. Of the patients uncontrolled, 61% were not on maximal medications, suggesting potential increases in control rates. Serious hypotensive events occurred in 1.8% of participants.
ACCOMPLISH BP control rates are the highest of any multi-national trial to date. Whereas current guidelines recommend combination therapy only for stage 2 hypertension, in this trial it is expedient and safe for both stage 1 and 2 hypertension.
ACCOMPLISH是一项“新一代”高血压试验，评估单片复方制剂疗法用于高危高血压的初始治疗。在基线时，97%的受试者在入组时接受抗高血压药物治疗，但只有37%的参与者血压得到控制（<140/90 mmHg）。单片复方制剂疗法可能提高控制率。
对10704例随机分组患者在6个月结束时（即受试者应完成所有药物滴定以实现血压控制的时间点）相对于基线的平均血压变化进行了检查。组内变化采用t检验进行检查。亚组之间的比较采用方差分析（ANOVA）和协方差分析（ANCOVA）。
平均（±标准差）血压从随机分组时的145±18/80±11 mmHg降至132±16/74±10 mmHg。在整个试验中，6个月时的血压控制率为73%（在美国为78%），糖尿病患者为43%，肾病患者为40%。在未得到控制的患者中，61%未使用最大剂量药物，这表明控制率可能会提高。1.8%的参与者发生了严重低血压事件。
ACCOMPLISH试验的血压控制率是迄今为止所有跨国试验中最高的。虽然目前的指南仅推荐联合治疗用于2级高血压，但在本试验中，联合治疗对于1级和2级高血压都是方便且安全的。
