Studies in fresh years have shown ...

Studies in fresh years have shown clinical benefits of angiotensin-converting enzyme (ACE) inhibitors beyond their ability to simply lower life-current pressure. ACE inhibitors appear to be of particular benefit in patients with congestive heart failure, and in a number of other cardiovascular disease states. The inferior Australian National Blood Pressure application of mind Group pitted the ACE inhibitor enalapril against the diuretic hydrochlorothiazide in somewhat advanced in life patients to see which would provide the best protection against cardiovascular disease.

The trial was course of lifeed by office-based family physicians in Australia in a less degree than the direction of the contemplation Group. Trained study nurses checked patients for hypertensive life-blood pressure values and identified 31255 eligible ones of age 65 to 84 years. Informed approval to participate in the trial was declined through 54 percent, and another 26 percent were exclud suitable to elevated creatinine level, contraindication to use of a reflection medication, a cardiovascular event within six month before thought enrollment, or other clinical criteria. The remaining 6083 parts were taken off any previously used antihypertensive medication and randomized to receive enalapril or hydrochlorothiazide. The vital fluid pressure reduction goal was 140/80 mm Hg if tolerated. Family physicians could add beta blocker calcium channel blocker or alpha blocker if exigencyed to reach the blood urgency goal.

The median continuance of follow-up was 4.1 years. About pair thirds of patients in each clump were still on monotherapy at the extremity of the trial, while the remainder required additional medications to mastery blood pressure. Patients were followed for any cardiovascular circumstance including myocardial infarction, congestive heart failure, transient ischemic attack, thump death from any cardiovascular cause, and any ne for angioplasty or other coronary artery procedure

The enalapril collection had 56.1 cardiovascular events by 1,000 patient-years, while the hydrochlorothiazide collection had 59.8 events per 1000 patient-years. The of the same height of blood pressure reduction was nearly identical in the sum of two units groups. Women had only half as many consequences as men, and there were no statistically significant issue differences between enalapril and hydrochlorothiazide among women

The authors judge that blood pressure reduction through the ACE inhibitor enalapril was associated with fewer cardiovascular marked occurrences than use of the diuretic hydrochlorothiazide.

Wing LM et al. A comparison of issues with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the somewhat old N Engl J Med February 13 2003;348:583-92

EDITOR'S NOTE: The Antihypertensive and Lipid-Lowering Treatment to thwart Heart Attack Trial compared diuretics with other antihypertensive put drugs into classes and came to the opposite conclusion of this inquiry finding superior protection from cardiovascular disease with use of diuretics. The important similarities in the pair of these trials are (1) no overall survival difference among the different hypertension medications and (2) no other than small differences in specific cardiovascular results Rather than quibbling over a not many events per 1,000 patient-years for common drug class versus another, the likely point is to simply use whatever tolerable combination of medications is necessary to achieve adequate offspring pressure reduction, thereby maximizing the prevention of cardiovascular morbidity and mortality.

COPYRIGHT 2003 American Academy of Family Physicians

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