Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial

Hansson, Lennart; Lindholm, Lars; Niskanen, Leo; Lanke, Jan; Hedner, Thomas; Niklason, Anders; Luomanmäki, K; Dahlöf, Björn; Fairé, Ulf dé; Mörlin, Claes; Karlberg, Bengt E.; Wester, Per‐Olov; Björck, J E

doi:10.1016/s0140-6736(98)05012-0

Cited by 1,803 publications

(1,157 citation statements)

References 31 publications

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“…5 In the CAPPP study, glucose, BMI, haemoglobin, age, the interaction between systolic baseline blood pressure and newly diagnosed hypertension, cholesterol and previous antihypertensive treatment were all significant risk factors in a multivariate analysis. 3,25 The CAPPP study included low-risk patients from Sweden and Finland indicating a less general population. Other known risk factors for diabetes mellitus development evaluated in, for example, West of Scotland Coronary Prevention Study such as high-sensitivity CRP, 26 triglycerides 27 and ALAT, 28 have not been evaluated in our population.…”

Section: Discussionmentioning

confidence: 99%

Predictors of new-onset diabetes mellitus in hypertensive patients: the VALUE trial

et al. 2008

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Diabetes mellitus often develops in patients with hypertension. We investigated predictors of diabetes mellitus development in hypertensives at risk of developing the disease in the VALUE trial population. Among the 9995 non-diabetic hypertensive patients at baseline, 1298 patients developed diabetes mellitus during the average follow-up of 4.2 years. New-onset diabetes mellitus was defined from adverse event reports, information about new antidiabetic medication and/or a fasting glucose X7.0 mmol l À1 at the end of trial. Twentyfive potential baseline predictors of new-onset diabetes mellitus were analysed by univariate logistic regression and 14 of 25 predictors were found to be statistically significant with a P-value o0.05. The predictors were in order of decreasing significance; glucose, body mass index (BMI), age, uric acid, non-Caucasian race, haemoglobin, heart rate, randomized study treatment, history of coronary heart disease (CHD), gender, total cholesterol, proteinuria, potassium and creatinine. Multivariate stepwise logistic regression analyses were used and potential baseline predictors of new-onset diabetes mellitus were considered significant by four different models (P-value o0.001). The final multivariate model selected included all patients, but not treatment group as a potential predictor, and the six significant predictors identified from this model were glucose, BMI, non-Caucasian race, age, heart rate and history of CHD. In conclusion, glucose and BMI were the most important predictors of new-onset diabetes mellitus in hypertensive patients at high cardiovascular risk, and easily accessible clinical characteristics strongly predict patients at risk of developing diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Predictors of new-onset diabetes mellitus in hypertensive patients: the VALUE trial

et al. 2008

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“…Corroborating and enhancing these results are the findings from the Captopril Prevention Project (CAPP), where treatment of hypertensive patients with captopril showed a 43% higher incidence of strokes compared to conventional treatment. 22 This should be somewhat mitigated by the 3 mmHg higher SBP in the captopril group. The results on stroke incidence were equivocal in the second Australian National Blood Pressure study (ANBP2) where elderly hypertensive patients treated with the ACEI enalapril showed a 9% higher incidence of fatal strokes, and a 7% lower incidence of nonfatal strokes compared to hydrochlorothiazide.…”

Section: Clinical and Experimental Evidencementioning

confidence: 97%

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Chrysant

2005

J Hum Hypertens

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Stroke is a major cause of death and disability and its incidence increases linearly with age and the level of systolic and diastolic blood pressure. Stroke, besides being a cause of long-term disability for the affected person, also imposes a significant burden on society and healthcare costs. Although good blood pressure control is very critical for stroke prevention, angiotensin receptor blockers (ARBs) may be superior to angiotensin-converting enzyme inhibitors (ACEIs) for the same degree of blood pressure control. This hypothesis has clinical and experimental support. ARBs prevent stroke incidence by blocking the angiotensin II (AII), AT 1 receptors preventing brain ischaemia and allowing AII to stimulate the unoccupied AT 2 receptors, which improve brain ischaemia. ACEIs, by reducing AII generation, are less effective in preventing stroke. This hypothesis provides evidence that AII plays an important role in the prevention of stroke. Certain ARBs like losartan, and telmisartan, irbesartan and candesartan possess additional properties which may play a role in stroke prevention, which is independent of AII. These include antiplatelet aggregating, hypouricemic, antidiabetic and atrial antifibrillatory effects. However, the most critical factor in stroke prevention is good blood pressure control irrespective of drug used.

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“…Currently, the choice of the drug for the initial treatment of hypertension is very strongly debuted. Although ARBs have been shown superior to b-blockers in the LIFE study 24 and ACEI better than diuretics in the Captopril Prevention Project (CAPPP) trial, 25 these findings have not been confirmed. On the contrary, the Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT) results suggest that chlorothalidone was better than lisinopril, both in lowering BP and diminishing cardiovascular events, but no differential effects of drug class on PP were found when all participants were considered.…”

Section: Discussionmentioning

confidence: 99%

Differential pulse pressure response to various antihypertensive drug families

et al. 2006

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Pulse pressure (PP) is emerging as a major pressure predictor of cardiac disease. The study comprised 10 185 untreated patients with essential hypertension. A total of 5395 men and 4790 women 56713 years old, with uncomplicated essential hypertension, after a 15-day washout period and after 6 months of antihypertensive monotherapy were included. All patients included in the final cohort were responders and had normalized their blood pressure. PP was decreased least with diuretics (À5 mm Hg) and most with angiotensin II receptor blockers (ARBs) and calcium antagonists (À15 mm Hg), followed by angiotensin-converting enzyme inhibitors (ACEI) (À12 mm Hg) a-and b-blockers (À10 and À9 mm Hg), differentiating among antihypertensive classes (Po0.001). The magnitude of PP fall was related to the degree of left ventricular (LV) mass reduction (Po0.001), seen best with ARBs (r ¼ 0.42) and least with ACEIs (r ¼ 0.18). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists, whereas diuretics confer poor response. PP was decreased least with diuretics (À5 mm Hg) and most with ARBs and calcium channel blockers (À15 mm Hg), followed by ACEI (À12 mm Hg) a-and b-blockers (À10 and À9 mm Hg), differentiating among antihypertensive classes (Po0.001). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists.

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Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial

Cited by 1,803 publications

References 31 publications

Predictors of new-onset diabetes mellitus in hypertensive patients: the VALUE trial

Predictors of new-onset diabetes mellitus in hypertensive patients: the VALUE trial

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Differential pulse pressure response to various antihypertensive drug families

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