Choice of Treatment for High Blood Pressure Has a Major Effect on Survival
November 30, 2001 | 12:00am
Potential for ACE inhibitors to save 80 more lives per thousand over five years.
The landmark, 16-year Glasgow Blood Pressure Clinic Study, which is a study of mortality in patients with high blood pressure has shown that the choice of treatment has a major effect on survival. Despite providing similar reductions in blood pressure, treatment with angiotensin converting enzyme (ACE) inhibitors showed consistently high protective effects while calcium channel blockers (CCBs) showed survival disadvantages to patients to whom they were prescribed.
In the study of more than 5,000 hypertensive (elevated blood pressure) patients attending the Glasgow Blood Pressure Clinic in Scotland, researchers compared groups of patients who used CCBs, to those who used another class of medications known as ACE inhibitors (55 percent; enalapril maleate), which many experts consider the 'gold standard' treatment for blood pressure and its related conditions.
"This study is important because it provides real-life evidence to add to more than a decade of rigorous, scientific evidence, that supports ACE inhibitors as the first choice for treating high blood pressure and its related conditions. CCBs should be considered only after exhausting all other treatment options," said Dr. Gordon McInnes, Senior Lecturer in Medicine and Therapeutics, University of Glasgow, Scotland.
"At least 80 more patients per thousand over five years would have survived in our clinic had they all been prescribed an ACE inhibitor rather than a CCB. These were people at high risk and it is clear that real lives can be saved in routine clinical practice if prescribing can be changed. ACE inhibition is clearly the way to protect those with cardiovascular disease, ranging from hypertension to frank heart failure."
These findings are good news for ACE inhibitors and patients who are treated with them. This supports more than a decade of research of this newer class of medicine," said Professor Pier Luigi Malini, Professor of Medical Therapeutics, S. Orsolo University Hospital, Bologna, Italy. "However, a surprising result occurred in patients who took calcium channel blockers - about one third more of those patients died compared to control patients while those in the ACE inhibitor group improved their survival by 25 percent."
A full analysis of the data shows that if all those patients in the study who received diuretic/beta blocker (conventional) therapy had been treated with ACE inhibitor enalapril maleate additional 35 lives would have been saved per 1,000 patients treated over a five year period. Conversely, if the patients in the study who received conventional therapy had been treated with CCBs, 45 more patients would have died, per 1,000 treated for five years. These results reinforce the findings with tens of thousands of patients in previous studies, which have proven the safety and efficacy of ACE inhibitors over the past two decades.
Long-Term, Real-Life Studies Have Great Significance
The study concerned 5,207 patients examined at the Glasgow Blood Pressure Clinic, who were first prescribed antihypertensive therapy from 1980 to 1995. This starting point was chosen because this was the time when ACE inhibitors and dihydropyridine calcium channel blockers first became available in the UK. For the purposes of this study, four groups were identified: those who had received ACE inhibitor therapy but never a calcium channel blocker (680); calcium channel blocker but never ACE inhibitor (1,416); ACE inhibitor and calcium channel blocker (879); neither ACE inhibitor nor calcium channel blocker (2,232).
Dr. McInnes explained that in the early 1980s when the study began, patients at the clinic had a relative risk of mortality twice that in the general population. Over the 15-year period of this analysis, mortality had declined sharply, to that of the general population. In other words, by the end of the study period there was no excess risk of mortality in treated hypertensive patients attending the clinic.
Positive Results Despite ACEI Patients Being Worse on Entry
To be certain that there were no other factors or biases which could explain the significant beneficial effects of ACE inhibitors, the investigators evaluated various measures in both groups (those who received and those who never received, ACE inhibitors). There was no difference between total cholesterol, blood sugar, serum creatinine, renal function and social class in the two groups.
However, those in the ACE inhibitor group had significantly higher blood pressure levels on entry to the study. In addition, a greater percentage of ACE inhibitor treated patients had received lipid-lowering therapy and antiplatelet treatment, indicating that they were more likely to have experienced a coronary event. Patients in the ACE inhibitor group tended to be older and included more smokers than the other groups. These differences would, if anything, mean that patients in the ACE inhibitor group were at greater risk of premature death.
It is best to always consult a doctor or a heart specialist about hypertension and the available treatment option like ACE inhibitor enalapril maleate which is marketed in the Philippines as Renitec.
Glasgow Blood Pressure Clinic study showed that:
* ACE inhibitors reduced all-cause mortality by 25 percent while CCBs increased
risk of death by one-third;
* ACE inhibitors reduced the risk of death from coronary artery disease by 35 percent while CCBs increased risk by nearly two-thirds;
* ACE inhibitors reduced all-vascular mortality by 16 percent while CCBs increased mortality by a half;
* ACE inhibitors reduced the risk of death from stroke by 20 percent;
* Beta blockers and diuretics had an intermediate effect on risk of all-cause mortality, death from ischaemic heart disease and all vascular deaths.
The landmark, 16-year Glasgow Blood Pressure Clinic Study, which is a study of mortality in patients with high blood pressure has shown that the choice of treatment has a major effect on survival. Despite providing similar reductions in blood pressure, treatment with angiotensin converting enzyme (ACE) inhibitors showed consistently high protective effects while calcium channel blockers (CCBs) showed survival disadvantages to patients to whom they were prescribed.
In the study of more than 5,000 hypertensive (elevated blood pressure) patients attending the Glasgow Blood Pressure Clinic in Scotland, researchers compared groups of patients who used CCBs, to those who used another class of medications known as ACE inhibitors (55 percent; enalapril maleate), which many experts consider the 'gold standard' treatment for blood pressure and its related conditions.
"This study is important because it provides real-life evidence to add to more than a decade of rigorous, scientific evidence, that supports ACE inhibitors as the first choice for treating high blood pressure and its related conditions. CCBs should be considered only after exhausting all other treatment options," said Dr. Gordon McInnes, Senior Lecturer in Medicine and Therapeutics, University of Glasgow, Scotland.
"At least 80 more patients per thousand over five years would have survived in our clinic had they all been prescribed an ACE inhibitor rather than a CCB. These were people at high risk and it is clear that real lives can be saved in routine clinical practice if prescribing can be changed. ACE inhibition is clearly the way to protect those with cardiovascular disease, ranging from hypertension to frank heart failure."
These findings are good news for ACE inhibitors and patients who are treated with them. This supports more than a decade of research of this newer class of medicine," said Professor Pier Luigi Malini, Professor of Medical Therapeutics, S. Orsolo University Hospital, Bologna, Italy. "However, a surprising result occurred in patients who took calcium channel blockers - about one third more of those patients died compared to control patients while those in the ACE inhibitor group improved their survival by 25 percent."
A full analysis of the data shows that if all those patients in the study who received diuretic/beta blocker (conventional) therapy had been treated with ACE inhibitor enalapril maleate additional 35 lives would have been saved per 1,000 patients treated over a five year period. Conversely, if the patients in the study who received conventional therapy had been treated with CCBs, 45 more patients would have died, per 1,000 treated for five years. These results reinforce the findings with tens of thousands of patients in previous studies, which have proven the safety and efficacy of ACE inhibitors over the past two decades.
Long-Term, Real-Life Studies Have Great Significance
The study concerned 5,207 patients examined at the Glasgow Blood Pressure Clinic, who were first prescribed antihypertensive therapy from 1980 to 1995. This starting point was chosen because this was the time when ACE inhibitors and dihydropyridine calcium channel blockers first became available in the UK. For the purposes of this study, four groups were identified: those who had received ACE inhibitor therapy but never a calcium channel blocker (680); calcium channel blocker but never ACE inhibitor (1,416); ACE inhibitor and calcium channel blocker (879); neither ACE inhibitor nor calcium channel blocker (2,232).
Dr. McInnes explained that in the early 1980s when the study began, patients at the clinic had a relative risk of mortality twice that in the general population. Over the 15-year period of this analysis, mortality had declined sharply, to that of the general population. In other words, by the end of the study period there was no excess risk of mortality in treated hypertensive patients attending the clinic.
Positive Results Despite ACEI Patients Being Worse on Entry
To be certain that there were no other factors or biases which could explain the significant beneficial effects of ACE inhibitors, the investigators evaluated various measures in both groups (those who received and those who never received, ACE inhibitors). There was no difference between total cholesterol, blood sugar, serum creatinine, renal function and social class in the two groups.
However, those in the ACE inhibitor group had significantly higher blood pressure levels on entry to the study. In addition, a greater percentage of ACE inhibitor treated patients had received lipid-lowering therapy and antiplatelet treatment, indicating that they were more likely to have experienced a coronary event. Patients in the ACE inhibitor group tended to be older and included more smokers than the other groups. These differences would, if anything, mean that patients in the ACE inhibitor group were at greater risk of premature death.
It is best to always consult a doctor or a heart specialist about hypertension and the available treatment option like ACE inhibitor enalapril maleate which is marketed in the Philippines as Renitec.
Glasgow Blood Pressure Clinic study showed that:
* ACE inhibitors reduced all-cause mortality by 25 percent while CCBs increased
risk of death by one-third;
* ACE inhibitors reduced the risk of death from coronary artery disease by 35 percent while CCBs increased risk by nearly two-thirds;
* ACE inhibitors reduced all-vascular mortality by 16 percent while CCBs increased mortality by a half;
* ACE inhibitors reduced the risk of death from stroke by 20 percent;
* Beta blockers and diuretics had an intermediate effect on risk of all-cause mortality, death from ischaemic heart disease and all vascular deaths.
BrandSpace Articles
<
>
