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

Lindon Wing, Christopher Reid, Philip Ryan, LJ Beilin, MA Brown, GLR Jennings, CI Johnston, JJ McNeil, GJ Macdonald, JE Marley, TO Morgan, MJ West, P Glasziou, Second Australian National Blood Pressure Study

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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.

Original languageEnglish
Pages (from-to)583-592
Number of pages10
JournalNew England Journal of Medicine
Volume348
Issue number7
DOIs
Publication statusPublished - 13 Feb 2003

Cite this

Wing, L., Reid, C., Ryan, P., Beilin, LJ., Brown, MA., Jennings, GLR., ... Second Australian National Blood Pressure Study (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. https://doi.org/10.1056/NEJMoa021716
Wing, Lindon ; Reid, Christopher ; Ryan, Philip ; Beilin, LJ ; Brown, MA ; Jennings, GLR ; Johnston, CI ; McNeil, JJ ; Macdonald, GJ ; Marley, JE ; Morgan, TO ; West, MJ ; Glasziou, P ; Second Australian National Blood Pressure Study. / A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. In: New England Journal of Medicine. 2003 ; Vol. 348, No. 7. pp. 583-592.
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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.",
author = "Lindon Wing and Christopher Reid and Philip Ryan and LJ Beilin and MA Brown and GLR Jennings and CI Johnston and JJ McNeil and GJ Macdonald and JE Marley and TO Morgan and MJ West and M Nelson and A Bruce and P Beckinsale and J Thompson and M McMurchie and G Fraser and D Gleave and V Cope and F DeLooze and S Moore and C Dibben and J Newbury and H Miles and B McDermott and K Willson and C Bear and M West and S Harrap and C Johnston and L Beilin and P Ryan and L Wing and C Reid and L Beilin and M Brown and P Ryan and L Wing and C Reid and G Jennings and P Fletcher and M Feneley and E Dewar and L Wing and C Reid and J McNeil and L Wing and J Marley and C Reid and C Johnston and G Jennings and L Wing and C Reid and J Marley and J Moss and P Webb and P Glasziou and F Boyle and J Primrose and L Wing and C Reid and Steven and L Piterman and {De Looze}, F and J Dickinson and J Gambrill and P Joseph and C Reid and D Hunt and G Donnan and L Wing and T Morgan and J Chalmers and J Whitworth and S MacMahon and C Silagy and {Second Australian National Blood Pressure Study}",
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Wing, L, Reid, C, Ryan, P, Beilin, LJ, Brown, MA, Jennings, GLR, Johnston, CI, McNeil, JJ, Macdonald, GJ, Marley, JE, Morgan, TO, West, MJ, Glasziou, P & Second Australian National Blood Pressure Study 2003, 'A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly' New England Journal of Medicine, vol. 348, no. 7, pp. 583-592. https://doi.org/10.1056/NEJMoa021716

A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. / Wing, Lindon; Reid, Christopher; Ryan, Philip; Beilin, LJ; Brown, MA; Jennings, GLR; Johnston, CI; McNeil, JJ; Macdonald, GJ; Marley, JE; Morgan, TO; West, MJ; Glasziou, P; Second Australian National Blood Pressure Study.

In: New England Journal of Medicine, Vol. 348, No. 7, 13.02.2003, p. 583-592.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly

AU - Wing, Lindon

AU - Reid, Christopher

AU - Ryan, Philip

AU - Beilin, LJ

AU - Brown, MA

AU - Jennings, GLR

AU - Johnston, CI

AU - McNeil, JJ

AU - Macdonald, GJ

AU - Marley, JE

AU - Morgan, TO

AU - West, MJ

AU - Nelson, M

AU - Bruce, A

AU - Beckinsale, P

AU - Thompson, J

AU - McMurchie, M

AU - Fraser, G

AU - Gleave, D

AU - Cope, V

AU - DeLooze, F

AU - Moore, S

AU - Dibben, C

AU - Newbury, J

AU - Miles, H

AU - McDermott, B

AU - Willson, K

AU - Bear, C

AU - West, M

AU - Harrap, S

AU - Johnston, C

AU - Beilin, L

AU - Ryan, P

AU - Wing, L

AU - Reid, C

AU - Beilin, L

AU - Brown, M

AU - Ryan, P

AU - Wing, L

AU - Reid, C

AU - Jennings, G

AU - Fletcher, P

AU - Feneley, M

AU - Dewar, E

AU - Wing, L

AU - Reid, C

AU - McNeil, J

AU - Wing, L

AU - Marley, J

AU - Reid, C

AU - Johnston, C

AU - Jennings, G

AU - Wing, L

AU - Reid, C

AU - Marley, J

AU - Moss, J

AU - Webb, P

AU - Glasziou, P

AU - Boyle, F

AU - Primrose, J

AU - Wing, L

AU - Reid, C

AU - Steven, null

AU - Piterman, L

AU - De Looze, F

AU - Dickinson, J

AU - Gambrill, J

AU - Joseph, P

AU - Reid, C

AU - Hunt, D

AU - Donnan, G

AU - Wing, L

AU - Morgan, T

AU - Chalmers, J

AU - Whitworth, J

AU - MacMahon, S

AU - Silagy, C

AU - Second Australian National Blood Pressure Study

PY - 2003/2/13

Y1 - 2003/2/13

N2 - 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.

AB - 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.

U2 - 10.1056/NEJMoa021716

DO - 10.1056/NEJMoa021716

M3 - Article

VL - 348

SP - 583

EP - 592

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 7

ER -