Author(s) |
(a) Management Committee on behalf of the High Blood Pressure Research Council of Australia
(b) Wing LMH, Reid CM, Ryan P, Beilin LJ, Brown MA, Jennings GLR, Johnston CI, McNeil JJ, Macdonald GJ, Marley JE, Morgan TO, West MJ |
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Title(s) |
(a) Australian comparative outcome trial of angiotensin-converting enzyme inhibitor- and diuretic-based treatment of hypertension in the elderly (ANBP2): objectives and protocol
(b) A comparison of outcomes with angiotensin-converting–enzyme inhibitors and diuretics for hypertension in elderly |
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Reference(s) |
(a) Clin Exp Pharmacol Physiol 1997;24:188-92
(b) N Engl J Med 2003:348:583–92 |
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Disease |
Hypertension
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Purpose |
To determine whether in hypertensive patients aged 65-84 there is any difference in total cardiovascular events (fatal and nonfatal) between antihypertensive treatment with an ACE inhibitor-based regimen and treatment with a diuretic-based regimen over a 5-year treatment period
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Study design |
Randomised, open with blinding of endpoint assessment
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Follow-up |
Median 4.1 years |
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Patients |
6083 patients (3044 ACE inhibitors, 3039 diuretics), mean age 71.9 years, with SBP ≥ 160 mm Hg and DBP ≥ 90 mm Hg |
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Treatment regimen |
ACE inhibitor group: step 1: ACE inhibitor (enalapril); step 2: beta-blocker or calcium antagonist or alpha-adrenoceptor antagonist; step 3: either of 2 drug classes not used in step 2 or a diuretic; step 4: drug from a class not used in step 2 or 3
Diuretic group: step 1: diuretic; step 2: beta-blocker or calcium antagonist or adrenoceptor antagonist; steps 3 and 4: as in ACE inhibitor group
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Results |
There were 695 cardiovascular events or deaths in the ACE-inhibitor group and 736 cardiovascular events or deaths in the diuretic group (hazard ratio 0.89, 95% CI 0.79–1.00; p = 0.05). 338 nonfatal cardiovascular events occurred in the ACE-inhibitor group and 380 in the diuretic group (hazard ratio 0.86, 95% CI 0.74–0.99; p = 0.03). There was no significant difference between the treatment groups in the rates of fatal cardiovascular or non-cardiovascular events |
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