- Question
- To determine whether, in hypertensive patients at high cardiovascular risk, combining an ACE inhibitor with a dihydropyridine calcium-channel blocker reduces cardiovascular events more than combining an ACE inhibitor with a thiazide diuretic.
- Design
- Randomized, double-blind, multicenter, multinational trial of 11506 patients. It was stopped early, after a mean follow-up of 36 months, when the prespecified stopping boundary was exceeded.
- Population
- Patients with hypertension at high risk for cardiovascular events.
- Intervention
- Benazepril plus amlodipine given as a single daily capsule, with dose titration.
- Control
- Benazepril plus hydrochlorothiazide given as a single daily capsule, with dose titration.
- Primary outcome
- Composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac arrest, and coronary revascularization.
- Results
- There were 552 primary-outcome events (9.6%) with benazepril-amlodipine and 679 (11.8%) with benazepril-hydrochlorothiazide, an absolute risk reduction of 2.2% and a relative risk reduction of 19.6% (HR 0.80; 95% CI 0.72 to 0.90; P<0.001). For the secondary endpoint of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke, the HR was 0.79 (95% CI 0.67 to 0.92; P=0.002). Mean achieved blood pressure was 131.6/73.3 mm Hg versus 132.5/74.4 mm Hg.
- Safety
- Adverse event rates were consistent with prior clinical experience with the study drugs.
- Conclusion
- The benazepril-amlodipine combination was superior to benazepril-hydrochlorothiazide in reducing cardiovascular events in high-risk hypertensive patients.
- Why it matters
- It challenged the preference for including a thiazide diuretic as the second agent and supported an ACE inhibitor plus calcium-channel blocker combination as a strategy in high-risk patients.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026