Article Figures & Data
Tables
- Table 1.
Trials Comparing Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers with Other Regimes in Hypertensive Patients*
Trial Year Type of Patients (n) Years of Follow-up (n) Drugs Compared Entry BP (mm Hg) BP Difference During Study P Primary Endpoint Relative Risk 95% CI Other Significant Outcome Differences P UKPDS7 1998 Hypertensive (n = 758) 9 Captopril vs atenolol 159/93 NS NA Cli diab event 1.1 0.86–1.41 None NS Diabetes death 1.27 0.82–1.97 NS Total mortality 1.14 0.81–1.61 NS CAPPP8 1999 Hypertensive (n = 10,985) 6.1 Captopril vs DIUs/β-blockers 162/100 Captopril; BP higher 2/2 NA MI, stroke, CV death 1.05 0.90–1.22 43% higher incidence of stroke in captopril group .004 STOP-29 1999 Hypertensive (n = 4418) 4.6 ACEIs vs conventional 194/98 NS NA CV death 1.01 0.84–1.22 None NS LIFE10 2002 Hypertensive (n = 9193) 4.8 Losartan vs atenolol 174/98 Losartan; SBP lower 1.1 .017 CV death, stroke, MI† 0.87 0.77–0.98 25% stroke reduction in losartan group .001 ALLHAT11 2002/2003 Hypertensive (n = 24,309) 4.9 Chlorthalidone vs lisinopril 146/84 Lisinopril SBP higher 2 <.001 Fatal CHD, nonfatal MI 0.99 0.91–1.08 Lisinopril group: 15% higher stroke .02 19% higher HF <.001 ANBP-212 2003 (n = 26,083) 4.1 ACEIs vs DIUs 168/91 NS NA CVS event total mortality‡ 0.89 0.79–1.00 In men, RR = 0.83 .02 In women, RR = 0.98; .98 JMIC-B13 2004 Hypertensive (n = 1650) 3 ACEIs vs nifedipine 145/82 ACEI BP higher 4/1 <.01 Cardiac event 1.05 0.81–1.37 ACEI group coronary lumen narrowed NS VALUE14 2004 Hypertensive (n = 15,245) 4.2 Amlodipine vs valsartan 155/88 Valsartan BP higher 2.1/1.7 <.0001 CV event 1.04 0.94–1.15 Valsartan group 19% higher MI .02 * Trials should show (1) no significant difference in primary endpoint in most studies and (2) the group with lower blood pressure had lower adverse clinical outcome regardless of strategy.
† P = .021.
‡ P = .05.
Cli diab, clinical diabetes; DIUs, diuretics; ACEIs, angiotensin-converting enzyme inhibitors; NS, not significant; NA, not available; BP, blood pressure; MI, myocardial infarction; CV, cardiovascular; SBP, systolic blood pressure; CHD: coronary heart disease; UKPDS, United Kingdom Prospective Diabetes Study Group; CAPPP, Captopril Prevention Project; STOP-2, Swedish Trial in Old Patients with Hypertension 2; LIFE, Losartan Intervention For Endpoint Reduction in Hypertension Study; ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; ANBP-2, Second Australian National Blood Pressure Study Group; JMIC-B, Japan Multicenter Investigation for Cardiovascular Diseases-B randomized trial; VALUE, Valsartan Antihypertensive Long-Term Use Evaluation; RR, relative risk; HF, heart failure.
- Table 2.
Trials Comparing Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers with Placebo in Patients at High Risk of Cardiovascular Events*
Trial Year Type of Patient (n) Years of Follow-up (n) ACEI Dosage ARB Dosage Entry BP (mm Hg) Mean BP Reduction† (mm Hg) Primary Endpoint Relative Risk 95% CI P HOPE26 2000 High risk (n = 9297) 5 Ramipril, 10 mg 139/79 3/2§ MI, stroke, CV death 0.78 0.70–0.86 <.001 PROGRESS‡27 2001 Stroke/TIA (n = 2561) 3.9 Perindopril, 4 mg 147/86 5/3 Stroke 0.95 0.81–1.23 NS EUROPA28 2003 IHD (n = 12,218) 4.2 Perindopril, 8 mg 137/82 5/2 CV death, MI, cardiac arrest 0.80 0.71–0.91 .0003 CAMELOT29 2004 IHD (n = 1328) 2 Enalapril, 20 mg 129/78 6/3 CV events 0.85 0.67–1.07 NS PEACE30 2004 IHD (n = 8290) 4.8 Trandolapril, 4 mg 133/78 3/1 CV death, MI, revascularization 0.96 0.88–1.06 NS JIKEI¶31 2007 High risk (n = 3081) 3.1 Valsartan, 40–160 mg 139/81 1/1‖ CV morbidity/mortality 0.61 0.47–0.79 .0002 TRANSCEND32 2008 High risk (n = 5926) 4.7 Telmisartan, 80 mg 141/82 4/2 CV death, MI, Stroke, CCF hospitalization 0.92 0.81–1.05 NS PROFESS33 2008 Stroke (n = 20,332) 2.5 Telmisartan, 80 mg 144/84 4/2 Stroke 0.95 0.86–1.04 NS * These trials do not consistently produce a significant reduction of clinical primary end point.
† As compared with placebo.
‡ Results of patients only on perindopril (single drug) compared with placebo.
§ HOPE substudy: Mean 24-hr BP reduction vs placebo, 10/4; P = .03. Mean nighttime BP reduction vs placebo, 17/8; P < .001.
‖ Results of patients on enalapril compared with placebo.
¶ Mean BP reduction vs placebo at 6 months, SBP 2.1 (P = .0005); DBP 2.1 (P < .0001). Mean BP reduction vs placebo at 1 year, SBP 1.5 (P = .0034); DBP 1.3 (P = .0003).
TIA, transient ischemic attack; IHD, ischemic heart disease; ACEI, angiotensin-converting enzyme inhibitor; BP, blood pressure; MI, myocardial infarction; CV, cardiovascular; ARB, angiotensin receptor blocker; CCF, congestive cardiac failure; NS, not significant; HOPE, Heart Outcomes Prevention Evaluation; PROGRESS, Perindopril Protection Against Recurrent Stroke Study; EUROPA, European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease; CAMELOT, Comparison of Arnlodipine vs Enalapril to Limit Occurrences of Thrombosis Trial; PEACE, Prevention of Events with ACEIs Trial; JIKEI, Jikei Heart Study; TRANCSCEND, Telmisartan Randomised Assessment Study in ACE-Intolerant Subjects with Cardiovascular Disease; PROFESS, Prevention Regimen for Effectively Avoiding Second Strokes Trial.
Trial Antihypertensive Drug Class (%) ACEI ARB ACEI + ARB BB CCB DIU ONTARGET (n = 25,620) 25 23 29 LIFE (n = 9193) 23 27 VALUE (n = 15,245) 26 24 ALLHAT (n = 24,309) 27 20 20 UKPDS (n = 758) 22 35 JMIC-B (n = 1650) 9 5 ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; DIU, diuretic; BB, β-blocker; ONTARGET, Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial; LIFE, Losartan Intervention For Endpoint Reduction in Hypertension Study; VALUE, Valsartan Antihypertensive Long-Term Use Evaluation; ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; UKPDS, United Kingdom Prospective Diabetes Study Group; JMIC-B, Japan Multicenter Investigation for Cardiovascular Diseases-B randomized trial.
