International Circulation: In the ACCOMPLISH trial， a 20% risk reduction for cardiovascular endpoints was noticed for the combination of benazepril and amlodipine， versus the combination of benazepril and a thiazide diuretic. Does this suggest that the combination of CCB and ACEI is better that that of ACEI and diuretics?

    《国际循环》：ACCOMPLISH 研究显示苯那普利联合氨氯地平较苯那普利联合氢氯噻嗪心血管终点事件减少20%，这是否提示CCB与ACEI的联合要优于ACEI与利尿剂的联合？

    Prof Lindholm: Well that is the ten thousand dollar question. I was on the safety committee of the ACCOMPLISH trial. It means that I had an open book for four or five years and we knew exactly what was happening. It was amazing. The difference in blood pressure in the trial is so tiny and even though you have such a tiny little bit of blood pressure difference， the patients that got a combination with amlodipine did so much better. So of course this is provocation for the Americans I believe who had been directed that a diuretic was recommended above everything else. So to answer your question， I want more studies like the ACCOMPLISH trial and the investigators， Ken Jamieson and others， should be commended for the way they carried out this trial and I think the results are immensely important. What they showed was the beauty of combining an ACE inhibitor with a calcium channel blocker instead of having the usual combination with a diuretic. Remember it was the same ACE inhibitor on both sides but in one arm it was added to a calcium channel blocker and in the other arm， a diuretic was added. I find the ACCOMPLISH trial one of the best trials we have had for a long time， was very well carried out and is an amazing study. Also remember， 60% of the patients had diabetes which almost makes it a diabetes trial. This is a nice set of results but with people like me， you always ask for more research. That’s how you finish almost every paper that you write – “and in view of this data， we call for more research in this field”.

    Prof. Lindholm：这个问题价值一万美元。我是ACCOMPLISH试验的安全委员会成员，了解4~5年的记录，明确知道发生了什么。ACCOMPLISH试验是长期以来我们所有研究中最好的试验之一 ，得到了很好的实施，该项研究令人惊叹。试验中两组患者血压上的差异是如此之小，但是即使只有这么小的血压差异，接受了氨氯地平联合治疗方案的患者结果要好许多，所以对于那些曾被误导认为利尿剂优先于任何其他药物的美国人来说这当然是一个挑衅。对于这个问题，我希望有更多类似ACCOMPLISH的研究，而研究者Jamerson等人应该因他们进行这一试验的方法而获得称赞。我认为该研究结果十分重要，证明了在应用同一种ACEI的情况下联用CCB相比于联用利尿剂的优点。还应记住的是，60%的患者有糖尿病，这使该试验几乎成为一项糖尿病试验。这是一套很好的结果，但是像我这类人总是想进行更多的研究，这就是我们在所写的几乎每篇论文中是如何结尾的——“那么考虑到这一数据，我们要求该领域中更多的研究”。

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