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Comparison Therapies in the Treatment of Hypertension. The ASCOT and ACCOMPLISH Trial

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Management of Hypertension

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Abstract

Combination therapy in hypertension, defined as the use of more than one antihypertensive agents in a hypertensive individual, is an issue of increasing interest, as in the majority of patients monotherapy does not achieve blood pressure control. Combination therapy seems safe, effective and convenient and several regimens are available in single-pill form, thereby facilitating compliance. Selection of the proper regimen remains a matter of debate, since data are in many cases conflicting and recommendations of guidelines of different hypertension societies are not always uniform. Although in many hypertension trials a large proportion of participants received more than one antihypertensive drugs, most of the available evidence is indirect, because few studies intended by design to compare two or more different combinations. ASCOT and ACCOMPLISH are considered the landmark trials in the comparison of combination therapies and had a great impact on hypertension guidelines and everyday clinical practice.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

ACC:

American College of Cardiology

ACCOMPLISH:

Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension

ACEI:

Angiotensin-converting enzyme inhibitor

AF:

Atrial fibrillation

AHA:

American Heart Association

AIx:

Augmentation index

ALLHAT:

Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

ARB:

Angiotensin receptor blocker

ASCOT:

Anglo-Scandinavian Cardiac Outcomes Trial

ASCOT-BPLA:

Anglo-Scandinavian Cardiac Outcomes Trial- Blood Pressure Lowering Arm

ASCOT-LLA:

Anglo-Scandinavian Cardiac Outcomes Trial- Lipid Lowering Arm

ASH:

American Society of Hypertension

BB:

Beta-blocker

BHS:

British Hypertension Society

BMI:

Body mass index

BNP:

Brain natriuretic peptide

BP:

Blood pressure

CAFE:

Conduit Artery Function Evaluation

CCB:

Calcium channel blockers

CHD:

Coronary heart disease

CI:

Confidence interval

CKD:

Chronic kidney disease

CV:

Cardiovascular

CVD:

Cardiovascular disease

eGFR:

Estimated glomerular filtration rate

ESC:

European Society of Cardiology

ESH:

European Society of Hypertension

ESRD:

End-stage renal disease

HDL:

High-density lipoprotein

HF:

Heart failure

HFrEF:

Heart failure with reduced ejection fraction

HOPE:

Heart Outcomes Prevention Evaluation

HR:

Hazard ratio

HTN:

Hypertension

ISH:

International Society of Hypertension

JNC:

Joint National Committee

LIFE:

Losartan Intervention for Endpoint reduction in hypertension

LV:

Left ventricle/left ventricular

LVH:

Left ventricular hypertrophy

MI:

Myocardial infarction

MRA:

Mineralocorticoid receptor antagonist

NICE:

National Institute for Health and Clinical Excellence

ONTARGET:

ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

PAD:

Peripheral artery disease

PWV:

Pulse wave velocity

RAAS:

Renin-angiotensin-aldosterone system

RCT:

Randomized controlled trial

SD:

Standard deviation

SHEP:

Systolic Hypertension in the Elderly Program

STEMI:

ST-segment elevation myocardial infarction

VALUE:

Valsartan Antihypertensive Long-term Use Evaluation

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Authors and Affiliations

  1. First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece

    Nikolaos Magkas

  2. Hipporcration General Hospital of Athens, Athens, Greece

    Athanasia Kapota

  3. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece

    Costas Tsioufis

  4. Georgetown University, Washington, DC, USA

    Costas Tsioufis

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  1. Nikolaos Magkas
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  1. Georgetown University and VA Medical Center, Washington, DC, USA

    Vasilios Papademetriou

  2. Fourth Internal Medicine Department, Evangelismos State General Hospital, Athens, Greece

    Emmanuel A. Andreadis

  3. Fourth Internal Medicine Department, Evangelismos State General Hospital, Athens, Greece

    Charalampia Geladari

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Magkas, N., Kapota, A., Tsioufis, C. (2019). Comparison Therapies in the Treatment of Hypertension. The ASCOT and ACCOMPLISH Trial. In: Papademetriou, V., Andreadis, E., Geladari, C. (eds) Management of Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-92946-0_10

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