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Review: ACE inhibitors, calcium antagonists, and more intensive blood pressure lowering strategies reduce cardiovascular events

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 QUESTION: In patients with hypertension, diabetes mellitus, coronary artery disease (CAD), or renal disease, what are the effects of angiotensin converting enzyme (ACE) inhibitors, calcium antagonists (CAs), and other blood pressure lowering drugs on mortality and major cardiovascular morbidity?

Data sources

In 1995, a registry was established of all large scale trials that were in progress or in advanced stages of planning.

Study selection

Studies were selected if there was a randomised comparison between patients allocated to a blood pressure lowering drug and placebo or to another active antihypertensive agent or to a blood pressure lowering strategy that had a different intensity. Trials had to have a minimum of 1000 patient years of follow up planned and must not have been published before July 1995.

Data extraction

Data were extracted on patient characteristics, discontinuation rates, blood pressure, and major outcomes. Individual patient data or summary data were combined.

Main results

Data from 15 trials (74 696 patients, mean age 62 y, 53% men) were included. Combining data from 4 placebo controlled trials of ACE inhibitors showed that active treatment led to relative reductions of 20% to 30% in stroke, CAD, and major cardiovascular events. Combining data from 2 …

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  • Sources of funding: National Health and Medical Research Council of Australia; Medical Foundation of the University of Sydney; National Heart Foundation of Australia; Health Research Council of New Zealand; British Heart Foundation; International Society of Hypertension; AstraZeneca; Bayer A G; Bristol Myers-Squibb; Glaxo Wellcome SpA; Hoechst A G; Merck; Pfizer; Searle and Servier.

  • For correspondence: Dr B Neal, Blood Pressure Lowering Treatment Trialists' Collaboration, Institute for International Health, University of Sydney, PO Box 576, Newtown, Sydney, New South Wales 2042, Australia. Fax +61 2 9351 0064.