{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T05:44:18Z","timestamp":1774676658282,"version":"3.50.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Acute declines in estimated glomerular filtration rate (eGFR) occur commonly after starting angiotensin\u2010converting enzyme inhibitors. Whether declines in eGFR that occur after simultaneously starting angiotensin\u2010converting enzyme inhibitors with other antihypertensive agents modifies the benefits of these agents on cardiovascular outcomes is unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We identified predictors of acute declines in eGFR (&gt;15% over 3 months) during randomization to benazepril plus amlodipine versus benazepril plus hydrochlorothiazide in the ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) trial. We then determined the relation between declines in eGFR (treated as a binary variable, \u226415% versus &gt;15% and separately, as a restricted spline variable) and the composite risk of fatal and nonfatal cardiovascular events using Cox proportional hazards models. We included 10\u2009714 participants (median age 68\u2009years [Q1 63, Q3 73]), of whom 1024 reached the trial end point over median follow\u2010up of 2.8\u2009years. Predictors of acute declines in eGFR&gt;15% over 3 months included assignment to hydrochlorothiazide (versus amlodipine) and higher baseline albuminuria. Overall, declines in eGFR \u226515% (versus &lt;15%) were associated with a 26% higher hazard of cardiovascular outcomes (95% CI, 1.07\u20131.48). In spline\u2010based analysis, risk for cardiovascular outcomes was higher in the hydrochlorothiazide arm at every level of decline in eGFR compared with the same magnitude of eGFR decline in the amlodipine arm.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p xml:lang=\"en\">Combined use of benazepril and amlodipine remains superior to benazepril and hydrochlorothiazide for cardiovascular outcomes, regardless of the magnitude of the decline in eGFR that occurred with initiation of therapy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.035177","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T10:07:42Z","timestamp":1721988462000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Acute Declines in Estimated Glomerular Filtration Rate in Patients Treated With Benazepril and Hydrochlorothiazide Versus Amlodipine and Risk of Cardiovascular Outcomes"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7774-2526","authenticated-orcid":false,"given":"Elaine","family":"Ku","sequence":"first","affiliation":[{"name":"University of California","place":["San Francisco"]},{"name":"University of California","place":["San Francisco"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2936-0619","authenticated-orcid":false,"given":"Kenneth","family":"Jamerson","sequence":"additional","affiliation":[{"name":"University of Michigan Ann\u2010Arbor","place":["Ann\u2010Arbor"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3813-3576","authenticated-orcid":false,"given":"Timothy P.","family":"Copeland","sequence":"additional","affiliation":[{"name":"University of California","place":["San Francisco"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1279-6179","authenticated-orcid":false,"given":"Charles E.","family":"McCulloch","sequence":"additional","affiliation":[{"name":"University of California","place":["San Francisco"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1448-327X","authenticated-orcid":false,"given":"Hocine","family":"Tighiouart","sequence":"additional","affiliation":[{"name":"Tufts Medical Center","place":["Boston"]},{"name":"Tufts University","place":["Boston"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark J.","family":"Sarnak","sequence":"additional","affiliation":[{"name":"Tufts University","place":["Boston"]},{"name":"Tufts University","place":["Boston"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.030112"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.5.685"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000343453"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j791"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2017010040"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2018040365"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.0000000000000426"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.19.2421"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-7061(04)00840-4"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0806182"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2020.03.009"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1198\/016214506000000735"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39548.738368.BE"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.09.021"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.118.313294"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.12060"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.09.038"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000003066"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.123.22425"}],"container-title":["Journal 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