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Topics in Evidence-Based Pharmacy Practice
2/17/2011: Is It Time To ACCELERATE Or Slow Down?
William D. Linn
Feik School of Pharmacy, University of the Incarnate Word, San Antonio, Texas
Excerpt:"One in 3 adults in the United States have high blood pressure (HBP), which equates to more than 74 million people.1 From 1996 to 2006 the death rate due to HBP increased 19.5%. Blood pressure (BP) control in men <60, 60 to 79, and ≥ 80 years of age has been reported as 38%, 36%, and 38% respectively; for women in the same age groups it was 38%, 28%, and 23%, respectively.2 Achieving a target BP is obviously a problem and many guidelines recommend initial combination therapy if the patient needs ≥ 20 mmHg reduction in their systolic blood pressure (SBP). However, this leads to the next question, which combination? The landmark trial, ACCOMPLISH, provided important data indicating that achieving a target BP with combination therapy was not enough.3 Major adverse cardiovascular events (MACE) were lower in an angiotensin converting-enzyme inhibitor (ACEI) + amlodipine regimen versus the traditional diuretic-based regimen despite virtually identical (<1 mmHg SBP difference) control. These results led to the next question; is blood pressure reduction a valid surrogate outcome for MACE? Perhaps it is not whether you reach your target BP but rather how you reach..."
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