作者简介：
Sverre Erik Kjeldsen：挪威Ullevaal 大学医院心脏病学部教授，密歇根大学心血管医学部兼职教授。欧洲高血压学会（ESH）前主席（2005~2007）。曾获国际高血压学会奖、2008 Lennart Hansson纪念奖。
我认为氨氯地平当与ACEI或ARB联合应用时会表现更好。他们在降压效应和靶器官保护方面有互补作用，并且在耐受性方面相互平衡，不良反应更少（氨氯地平联合ACEI或ARB时，水肿的减少尤其明显）。
ACCOMPLISH试验显示CCB/ACEI联合方案较HCTZ/ACEI联合方案降低20%的硬终点事件发生率——这足以提前终止试验，并从根本上再次证实了ASCOT试验中CCB/ACEI vs. HCTZ/β受体阻滞剂对比的结果。ASCOT试验中CCB/ACEI组中血压更低，而我们在ACCOMPLISH试验中未观察到这种差异——所以，我们推断其获益独立于降压效应。氯噻酮有可能优于HCTZ。因此，美国JNC8指南在考虑以氯噻酮取代HCTZ作为一线治疗进行推荐。当然你可能主张在作出强烈推荐之前ACCOMPLISH还需要进一步确认——通常指南建议需要基于至少2项显示一致原则的研究。我仍然认为，ACEI/HCTZ 和 ARB/HCTZ是优秀的联合用药方案。
I think， at this stage， BP variability is an interesting hypothesis， but one that needs further research to be proven. I would rather say that amlodipine behaves differently (better) when it acts in combination with an ACEI (or ARB). They are complementary regarding BP lowering effects and vessel/target organ protection and they balance each other regarding tolerability with less side effects (particularly less oedema from amlodipine when combined with an ACEI or ARB).
ACCOMPLISH showed that CCB/ACEI combination is 20% better than HCTZ/ACEI combination in hard endpoint reduction - enough to stop the study early and essentially confirming what ASCOT suggested as far as CCB/ACEI vs. HCTZ/beta-blocker. In ASCOT there was somewhat lower BP for the CCB/ACEI. We did not see this in ACCOMPLISH - thus we suspect a benefit beyond the BP lowering effect. Possibly， chlorthalidone is better than HCTZ. Thus， in the USA， the Joint National Committee 8 is considering removing HCTZ from their first line recommendation and favoring chlorthalidone instead. You may also claim that ACCOMPLISH may need confirmation before making too strong a recommendation - we usually base our guidelines on at least two studies showing a principle. I still think， though， ACEI/HCTZ and ARB/HCTZ are excellent drug combinations. Think of LIFE， in which we， for first time in history of hypertension research， were able to show superiority for one combination over another. (ARB/HCTZ was better than HCTZ/beta-blocker.)