Reduced Cardiovascular Morbidity and Mortality in Hypertensive Diabetic Patients on First-Line Therapy With an ACE Inhibitor Compared With a Diuretic/β-Blocker–Based Treatment Regimen
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OBJECTIVE—The Captopril Prevention Project (CAPPP) evaluated the effects of an ACE inhibitor–based therapeutic regimen on cardiovascular mortality and morbidity in hypertension. One planned subanalysis of the CAPPP was to evaluate the outcome in the diabetic patient group. RESEARCH DESIGN AND METHODS—In the CAPPP, 572 (4.9% of 10,985 hypertensive patients) had diabetes at baseline and were studied according to a prospective, randomized, open, blinded, end point trial design. Patients aged 25–66 years with diastolic blood pressure ≥100 mmHg were included and randomized to receive either captopril or conventional antihypertensive treatment (diuretics and/or β-blockers). RESULTS—The primary end point, fatal and nonfatal myocardial infarction and stroke as well as other cardiovascular deaths, was markedly lower in the captopril than in the conventional therapy group (relative risk [RR] = 0.59; P = 0.018). Specifically, cardiovascular mortality, defined as fatal stroke and myocardial infarction, sudden death, and other cardiovascular death, tended to be lower in the captopril group (RR = 0.48; P = 0.084), and no difference was observed between the study groups for stroke (RR = 1.02; P = 0.96). Myocardial infarctions were less frequent in the captopril group than in the conventional therapy group (RR = 0.34; P = 0.002). Furthermore, total mortality was lower in the captopril as compared with the conventional therapy group (RR = 0.54; P = 0.034). Patients with impaired metabolic control seemed to benefit the most from ACE inhibitor–based therapy. CONCLUSIONS—Captopril is superior to a diuretic/β-blocker antihypertensive treatment regimen in preventing cardiovascular events in hypertensive diabetic patients, especially in those with metabolic decompensation.
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Evidence strongly supports using a renin-angiotensin system inhibitor, particularly in patients with evidence of end-organ damage such as albuminuria and left ventricular hypertrophy.
“All available BP-lowering drugs can be used, but evidence strongly supports using a renin-angiotensin system (RAS) inhibitor (ACE-I, ARB), particularly in patients with evidence of end-organ damage (albuminuria and left ventricular [LV] hypertrophy).”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [214]
In meta-analyses, blood pressure-lowering therapy was found to decrease risk of cerebrovascular diseases.
“In meta-analyses, blood pressure-lowering therapy was found to decrease risk of cerebrovascular diseases810).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [810]
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- Authors
- Niskanen, L., Hedner, T., Hansson, L., Lanke, J., Niklason, A., & for the CAPPP study group
- Affiliations
- University of Eastern Finland (FI)
- ORCID
- Niskanen, Leo
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2001-12-01
- Volume
- 24
- Issue
- 12
- Pages
- 2091-2096
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2112122483
- Cited by
- 219
- References
- 38
- Citations by year
- 2024: 5 · 2023: 6 · 2022: 2 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 10 · 2017: 7 · 2016: 7 · 2015: 8 · 2014: 10 · 2013: 5 · 2012: 6
- FWCI
- 12.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- captopril, ACE inhibitors, hypertension, diabetes mellitus, cardiovascular morbidity, cardiovascular mortality, myocardial infarction, stroke, diuretics, beta-blockers, antihypertensive therapy, metabolic control
- MeSH terms
- Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Blood Glucose, Captopril, Cardiovascular Diseases, Cholesterol, Diabetic Angiopathies, Diuretics, Female, Humans, Hypertension, Cholesterol, HDL, Male, Middle Aged, Morbidity, Myocardial Infarction, Prospective Studies, Risk, Body Mass Index, Stroke, Diabetes Complications
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