Blood pressure in renal disease: how to accomplish the goal?

The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial showed that initial antihypertensive therapy with benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing progression of chronic kidney disease as well as cardiovascular morbidity and mortality in renal patients. The renal results of the ACCOMPLISH trial strongly support the recommendation of using calcium channel blockers as second antihypertensive agent added to renin-angiotensin axis-blocking drugs. This review discusses the validity of these data and their relationship with the cumulative evidence on the effects of calcium antagonists on renal disease progression.