Cited by 1,790Blood Pressure and Hypertension StudiesSodium Intake and HealthCardiovascular Health and Disease Prevention

Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials

Blood Pressure Lowering Treatment Trialists' Collaboration·2000·The Lancet

Abstract

Background This programme of overviews of randomised trials was established to investigate the effects of angiotensin-converting-enzyme (ACE) inhibitors, calcium antagonists, and other blood-pressure-lowering drugs on mortality and major cardiovascular morbidity in several populations of patients. We did separate overviews of trials comparing active treatment regimens with placebo, trials comparing more intensive and less intensive blood-pressure-lowering strategies, and trials comparing treatment regimens based on different drug classes.Methods The hypotheses to be investigated, the trials to be included, and the outcomes to be studied were all selected before the results of any participating trial were known. Individual participant data or group tabular data were provided by each trial and combined by standard statistical techniques.Findings The overview of placebo-controlled trials of ACE inhibitors (four trials, 12,124 patients mostly with coronary heart disease) revealed reductions in stroke (30% [95% CI 15-43]), coronary heart disease (20% [11-28]), and major cardiovascular events (21% [14-27]). The overview of placebo-controlled trials of calcium antagonists (two trials, 5520 patients mostly with hypertension) showed reductions in stroke (39% [15-56]) and major cardiovascular events (28% [13-41]). In the overview of trials comparing blood-pressure-lowering strategies of different intensity (three trials, 20,408 patients with hypertension), there were reduced risks of stroke (20% [2-35]), coronary heart disease (19% [2-33]), and major cardiovascular events (15% [4-24]) with more intensive therapy. In the overviews comparing different antihypertensive regimens (eight trials, 37,872 patients with hypertension), several differences in cause-specific effects were seen between calcium-antagonist-based therapy and other regimens, but each was of borderline significance.Interpretation Strong evidence of benefits of ACE inhibitors and calcium antagonists is provided by the overviews of placebo-controlled trials. There is weaker evidence of differences between treatment regimens of differing intensities and of differences between treatment regimens based on different drug classes. Data from continuing trials of blood-pressure-lowering drugs will substantially increase the evidence available about any real differences that might exist between regimens.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(00)03307-9

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Blood Pressure Lowering Treatment Trialists' Collaboration
Affiliations
The University of Sydney (AU)
Corresponding author
Blood Pressure Lowering Treatment Trialists' Collaboration
Venue
The Lancet
Publisher
Elsevier BV
Published
2000-12
Volume
356
Issue
9246
Pages
1955-1964
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2297753288
Cited by
1,790
References
52
Citations by year
2026: 6 · 2025: 12 · 2024: 17 · 2023: 21 · 2022: 21 · 2021: 34 · 2020: 29 · 2019: 29 · 2018: 36 · 2017: 56 · 2016: 73 · 2015: 57 · 2014: 72 · 2013: 68 · 2012: 52
FWCI
89.17
Type
journal article
Language
en
Open access
closed
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • British Heart Foundation
  • National Heart Foundation of Australia
  • National Health and Medical Research Council
  • National Medical Research Council
  • Health Research Council of New Zealand
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
ACE inhibitors, calcium channel blockers, blood pressure medication, hypertension, antihypertensive therapy, stroke prevention, coronary artery disease, major cardiovascular events, mortality, treatment intensity, drug class comparison
MeSH terms
Aged, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Calcium Channel Blockers, Coronary Disease, Female, Heart Failure, Humans, Hypertension, Male, Middle Aged, Randomized Controlled Trials as Topic, Treatment Outcome, Stroke

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review