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

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.

doi:10.1056/nejmoa021716

Cited by 1,130Blood Pressure and Hypertension StudiesRenin-Angiotensin System StudiesSodium Intake and Health

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

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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. +4 more·2003·New England Journal of Medicine

DOI 10.1056/nejmoa021716

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Abstract

BACKGROUND: Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the renin-angiotensin system confer benefit beyond the reduction of blood pressure alone. We compared the outcomes in older subjects with hypertension who were treated with angiotensin-converting-enzyme (ACE) inhibitors with the outcomes in those treated with diuretic agents. METHODS: We conducted a prospective, randomized, open-label study with blinded assessment of end points in 6083 subjects with hypertension who were 65 to 84 years of age and received health care at 1594 family practices. Subjects were followed for a median of 4.1 years, and the total numbers of cardiovascular events in the two treatment groups were compared with the use of multivariate proportional-hazards models. RESULTS: At base line, the treatment groups were well matched in terms of age, sex, and blood pressure. By the end of the study, blood pressure had decreased to a similar extent in both groups (a decrease of 26/12 mm Hg). There were 695 cardiovascular events or deaths from any cause in the ACE-inhibitor group (56.1 per 1000 patient-years) and 736 cardiovascular events or deaths from any cause in the diuretic group (59.8 per 1000 patient-years; the hazard ratio for a cardiovascular event or death with ACE-inhibitor treatment was 0.89 [95 percent confidence interval, 0.79 to 1.00]; P=0.05). Among male subjects, the hazard ratio was 0.83 (95 percent confidence interval, 0.71 to 0.97; P=0.02); among female subjects, the hazard ratio was 1.00 (95 percent confidence interval, 0.83 to 1.21; P=0.98); the P value for the interaction between sex and treatment-group assignment was 0.15. The rates of nonfatal cardiovascular events and myocardial infarctions decreased with ACE-inhibitor treatment, whereas a similar number of strokes occurred in each group (although there were more fatal strokes in the ACE-inhibitor group). CONCLUSIONS: Initiation of antihypertensive treatment involving ACE inhibitors in older subjects, particularly men, appears to lead to better outcomes than treatment with diuretic agents, despite similar reductions of blood pressure.

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Authors: Wing, L. M. H., Reid, C. M., Ryan, P., Beilin, L. J., Brown, M. A., Jennings, G. L. R., Johnston, C. I., McNeil, J. J., Macdonald, G. J., Marley, J. E., Morgan, T. O., & West, M. J.
Affiliations: Flinders University (AU)
The University of Adelaide (AU)
The University of Western Australia (AU)
UNSW Sydney (AU)
Monash University (AU)
MSD (Australia) (AU)
Newcastle University (GB)
The University of Melbourne (AU)
The University of Queensland (AU)
ORCID: Reid, Christopher M.
Beilin, Lawrence J.
Brown, Mark A.
Jennings, Garry L.R.
McNeil, John J.
Morgan, Trefor O.
West, Malcolm J.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2003-02-13
Volume: 348
Issue: 7
Pages: 583-592
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa021716
OpenAlex: W2146851676
Cited by: 1,130
References: 44
Citations by year: 2026: 8 · 2025: 10 · 2024: 12 · 2023: 13 · 2022: 11 · 2021: 21 · 2020: 11 · 2019: 17 · 2018: 31 · 2017: 28 · 2016: 29 · 2015: 37 · 2014: 39 · 2013: 42 · 2012: 54
FWCI: 98.38
Type: journal article
Language: en
Open access: green
research.bond.edu.au
Licence: other-oa
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
eCite Digital Repository (University of Tasmania) (submittedVersion)
Bond University Research Portal (Bond University) (submittedVersion, other-oa)
UWA Profiles and Research Repository (UWA) (submittedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Flinders Academic Commons (Flinders University) (submittedVersion)
Figshare (submittedVersion, cc-by)
ANU Open Research (Australian National University) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Keywords: hypertension, older adults, ACE inhibitors, diuretics, renin-angiotensin system, cardiovascular events, mortality, myocardial infarction, stroke, sex differences, family medicine patients, blood pressure reduction, beta-blockers, cardiovascular risk reduction, cardiovascular risk stratification
MeSH terms: Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Diuretics, Drug Therapy, Combination, Female, Humans, Hypertension, Male, Prospective Studies, Sex Factors

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

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