A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly

Wing, Lindon M. H., Reid, Christopher M., Ryan, Philip, Beilin, Lawrence J., Brown, Mark A., Jennings, Garry L. R., Johnston, Colin I., McNeil, John J., Macdonald, Graham J., Marley, John E., Morgan, Trefor O., West, Malcolm J., Second Australian National Blood Pressure Study Group and Delooze, F. (2003) A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. New England Journal of Medicine, 348 7: 583-592. doi:10.1056/NEJMoa021716


Author Wing, Lindon M. H.
Reid, Christopher M.
Ryan, Philip
Beilin, Lawrence J.
Brown, Mark A.
Jennings, Garry L. R.
Johnston, Colin I.
McNeil, John J.
Macdonald, Graham J.
Marley, John E.
Morgan, Trefor O.
West, Malcolm J.
Second Australian National Blood Pressure Study Group
Delooze, F.
Title A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 1533-4406
0028-4793
Publication date 2003-02-13
Sub-type Article (original research)
DOI 10.1056/NEJMoa021716
Volume 348
Issue 7
Start page 583
End page 592
Total pages 10
Place of publication Boston, U.S.A.
Publisher Massachusetts Medical Society
Language eng
Subject 320100 Medicine - General
1102 Cardiovascular Medicine and Haematology
1103 Clinical Sciences
Formatted abstract Background :

Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the renin–angiotensin system confer benefit beyond the reduction of blood pressure alone. We compared the outcomes in older subjects with hypertension who were treated with angiotensin-converting–enzyme (ACE) inhibitors with the outcomes in those treated with diuretic agents.

Methods:

We conducted a prospective, randomized, open-label study with blinded assessment of end points in 6083 subjects with hypertension who were 65 to 84 years of age and received health care at 1594 family practices. Subjects were followed for a median of 4.1 years, and the total numbers of cardiovascular events in the two treatment groups were compared with the use of multivariate proportional-hazards models.

Results:

At base line, the treatment groups were well matched in terms of age, sex, and blood pressure. By the end of the study, blood pressure had decreased to a similar extent in both groups (a decrease of 26/12 mm Hg). There were 695 cardiovascular events or deaths from any cause in the ACE-inhibitor group (56.1 per 1000 patient-years) and 736 cardiovascular events or deaths from any cause in the diuretic group (59.8 per 1000 patient-years; the hazard ratio for a cardiovascular event or death with ACE-inhibitor treatment was 0.89 [95 percent confidence interval, 0.79 to 1.00]; P=0.05). Among male subjects, the hazard ratio was 0.83 (95 percent confidence interval, 0.71 to 0.97; P=0.02); among female subjects, the hazard ratio was 1.00 (95 percent confidence interval, 0.83 to 1.21; P=0.98); the P value for the interaction between sex and treatment-group assignment was 0.15. The rates of nonfatal cardiovascular events and myocardial infarctions decreased with ACE-inhibitor treatment, whereas a similar number of strokes occurred in each group (although there were more fatal strokes in the ACE-inhibitor group).

Conclusions:

Initiation of antihypertensive treatment involving ACE inhibitors in older subjects, particularly men, appears to lead to better outcomes than treatment with diuretic agents, despite similar reductions of blood pressure.
Copyright © 2003 Massachusetts Medical Society

Keyword Hypertension
ACE inhibitors
Diuretic agents
Beta-blockers
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown
Additional Notes Additional members of the Second Australian National Blood Pressure Study Group listed in article Appendix

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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