Context

Several hypertension drug trials have suggested that the intensity of initial treatment may be important in determining blood pressure (BP) responses to incrementally more intense antihypertensive drug therapy over the longer term.1 2 In these studies, diminished early BP response portended less subsequent blood BP lowering despite the addition of extra antihypertensive agents. It has long been the traditional wisdom that attainment and maintenance of BP control over the long term, not the short term, was the most important determinant of risk for pressure-related complications (eg, stroke, retinopathy, heart failure). Accordingly, this assumption was not questioned until the results of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial were reported, which clearly linked greater early BP control with amlodipine relative to valsartan, to a lesser risk of myocardial infarction, stroke, heart failure hospitalisations and death, most notably during the first 6 months postrandomisation.1

Thus, the Aliskerin and the Calcium Channel Blocker Amlodipine Combination as an Initial Treatment Strategy for Hypertension Control (ACCELERATE) study was undertaken to evaluate whether initial antihypertensive monotherapy with two agents of different classes would impair the long-term (24-week) BP response, relative to the initial combined use of both. ACCELERATE was designed specifically to prospectively test the hypothesis that initial treatment intensity …