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

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dc.contributor.authorWing, L.
dc.contributor.authorReid, C.
dc.contributor.authorRyan, P.
dc.contributor.authorBeilin, L.
dc.contributor.authorBrown, M.
dc.contributor.authorJennings, G.
dc.contributor.authorJohnston, C.
dc.contributor.authorMcNeil, J.
dc.contributor.authorMacDonald, G.
dc.contributor.authorMarley, J.
dc.contributor.authorMorgan, T.
dc.contributor.authorWest, M.
dc.date.issued2003
dc.descriptionCopyright © 2003 Massachusetts Medical Society. All rights reserved.
dc.description.abstractBackground 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.
dc.description.statementofresponsibilityLindon M.H. Wing, Christopher M. Reid, Philip Ryan, Lawrence J. Beilin, Mark A. Brown, Garry L.R. Jennings, Colin I. Johnston, John J. McNeil, Graham J. Macdonald, John E. Marley, Trefor O. Morgan, and Malcolm J. West, for the Second Australian National Blood Pressure Study Group
dc.identifier.citationNew England Journal of Medicine, 2003; 348(7):583-592
dc.identifier.doi10.1056/NEJMoa021716
dc.identifier.issn0028-4793
dc.identifier.issn1533-4406
dc.identifier.urihttp://hdl.handle.net/2440/4230
dc.language.isoen
dc.publisherMassachusetts Medical Soc
dc.source.urihttp://content.nejm.org.proxy.library.adelaide.edu.au/cgi/content/abstract/348/7/583
dc.subjectSecond Australian National Blood Pressure Study Group
dc.subjectHumans
dc.subjectCardiovascular Diseases
dc.subjectHypertension
dc.subjectAntihypertensive Agents
dc.subjectDiuretics
dc.subjectAngiotensin-Converting Enzyme Inhibitors
dc.subjectDrug Therapy, Combination
dc.subjectProspective Studies
dc.subjectSex Factors
dc.subjectBlood Pressure
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectFemale
dc.subjectMale
dc.titleA comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly
dc.typeJournal article
pubs.publication-statusPublished

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