以ACEI为基础的早期联合治疗课件.pptVIP

* * Patients will be randomized to amlodipine/benazepril 5/20 mg or benazepril/HCTZ 20/12.5 mg, and will have their doses force-titrated to standard maintenance doses of amlodipine/benazepril 5/40 mg, and benazepril/HCTZ 40/12.5 mg during the first 2 months. The doses can be increased to 10/40 mg or 40/25 mg, respectively, and after 3 months other antihypertensive agents (excluding the drug classes involved in the primary treatments) may be added to achieve blood pressure 140/90 mmHg (130/80 mmHg for patients with diabetes or renal insufficiency). Investigators will be strongly encouraged to reach target blood pressure in all patients. Patients will be seen at 3 months, 6 months, and thereafter at 6-month intervals until the end of the trial.1 (Jamerson et al. Am J Hypertens. 2004;17: A) ACCOMPLISH is an event-driven trial: patients will be treated until 1,642 primary cardiovascular events have been reported. It is estimated this will take approximately 5 years, including the 18 months of recruitment. 1. Jamerson KA, Bakris GL, Wun CC, et al. Rationale and design of the Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH) trial: the first randomized controlled trial to compare the clinical outcome effects of first-line combination therapies in hypertension. Am J Hypertens. 2004;17:793–801. * * * * * * * * Large-scale clinical trials have addressed a number of questions about the treatment of hypertension. The earliest trials, such as the VA Cooperative Studies, MRC1 and ANHBP 1, investigated whether to treat diastolic hypertension. Determining the goal of treatment was the question addressed by HDFP, HOT, and UKPDS, later trials. Whether to treat diastolic BP elevation in older patients was investigated in the EWPHE, MRC, STOP, and SCOPE studies. Whether to treat systolic BP elevation in older patients was answered by SHEP, Syst-Eur and Syst-China. Many trials have addressed the question “Wh