A Comparison of Outcomes with Angiotensin-Converting–Enzyme Inhibitors and Diuretics for Hypertension in the Elderly

• Published in: The New England journal of medicine Vol. 348; no. 7; pp. 583 - 592
• Main Authors: Wing, Lindon M.H, Reid, Christopher M, Ryan, Philip, Beilin, Lawrence J, Brown, Mark A, Jennings, Garry L.R, Johnston, Colin I, McNeil, John J, Macdonald, Graham J, Marley, John E, Morgan, Trefor O, West, Malcolm J
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 13.02.2003
• Subjects: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Diuretics - therapeutic use; Drug Therapy, Combination; Female; Humans; Hypertension - drug therapy; Hypertension - mortality; Male; Medical sciences; Prospective Studies; Sex Factors; Human; Diuretic; Hypertension; Chemotherapy; Randomization; Treatment; Cardiovascular disease; Elderly; Comparative study; ACE inhibitor; Result
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa021716

This prospective, open-label, randomized study compared the outcomes in hypertensive subjects 65 to 84 years of age who received therapy with angiotensin-converting–enzyme (ACE) inhibitors or diuretic agents. The rate of cardiovascular events or death from any cause was lower among male subjects who received ACE inhibitors. In older persons an ACE inhibitor may improve outcomes. Placebo-controlled studies of the drug treatment of mild-to-moderate hypertension have demonstrated that the reduction of blood pressure is associated with a reduced risk of cardiovascular events and death. 1 – 7 This benefit was first shown with diuretics, beta-blockers, or both as initial therapy. 1 – 6 Since those studies were conducted, newer classes of antihypertensive agents, including angiotensin-converting–enzyme (ACE) inhibitors, calcium-channel antagonists, and angiotensin II antagonists, have become widely accepted into practice. When our study began, no data were available indicating whether therapy involving these newer agents would have the same benefit in persons with hypertension. However, evidence of a benefit of treatment . . .