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Therapeutics
ACE inhibitors reduced cardiovascular events and all cause mortality in elderly people with hypertension

https://doi.org/10.1136/ebm.8.5.144

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    (2003) N Engl J Med 348, 583. Wing LM, Reid CM, Ryan P, et al.. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly.. ;. :. –92.
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 QUESTION: In older people with hypertension, is a regimen based on angiotensin converting enzyme (ACE) inhibitors more effective than one based on diuretics for reducing cardiovascular events and all cause mortality?

    Design

    Randomised (allocation concealed*), blinded (outcome assessors),* controlled trial with median follow up of 4.1 years (Second Australian National Blood Pressure Study [ANBP2]).

    Setting

    1594 family medical practices in Australia.

    Patients

    6083 patients who were 65–84 years of age (mean age 72 y, 51% women) without recent (previous 6 mo) cardiovascular events and had hypertension (defined as systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥90 mm Hg with systolic blood pressure ≥140 mm Hg). Exclusion criteria included any life threatening illness, a plasma creatinine concentration >221 μmol/l, malignant hypertension, and dementia. Follow up was 100%.

    Intervention

    Patients were allocated to a treatment regimen …

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    Footnotes

    • Sources of funding: Australian Commonwealth Department of Health and Aging; National Health and Medical Research Council of Australia; Merck Sharp & Dohme, Australia.

    • For correspondence: Dr C M Reid, Baker Heart Research Institute, Melbourne, Victoria, Australia. chris.reid{at}baker.edu.au

    • Abstract and commentary also appear in ACP Journal Club.

    • ↵* See glossary.