Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients.
Eur Heart J
; 33(16): 2088-97, 2012 Aug.
Article
em En
| MEDLINE
| ID: mdl-22511654
ABSTRACT
AIMS:
Renin-angiotensin-aldosterone system (RAAS) inhibitors are well established for the reduction in cardiovascular morbidity, but their impact on all-cause mortality in hypertensive patients is uncertain. Our objective was to analyse the effects of RAAS inhibitors as a class of drugs, as well as of angiotensin-converting enzyme (ACE) inhibitors and AT1 receptor blockers (ARBs) separately, on all-cause mortality. METHODS ANDRESULTS:
We performed a pooled analysis of 20 cardiovascular morbidity-mortality trials. In each trial at least two-thirds of the patients had to be diagnosed with hypertension, according to the trial-specific definition, and randomized to treatment with an RAAS inhibitor or control treatment. The cohort included 158 998 patients (71 401 RAAS inhibitor; 87 597 control). The incidence of all-cause death was 20.9 and 23.3 per 1000 patient-years in patients randomized to RAAS inhibition and controls, respectively. Overall, RAAS inhibition was associated with a 5% reduction in all-cause mortality (HR 0.95, 95% CI 0.91-1.00, P= 0.032), and a 7% reduction in cardiovascular mortality (HR 0.93, 95% CI 0.88-0.99, P= 0.018). The observed treatment effect resulted entirely from the class of ACE inhibitors, which were associated with a significant 10% reduction in all-cause mortality (HR 0.90, 95% CI 0.84-0.97, P= 0.004), whereas no mortality reduction could be demonstrated with ARB treatment (HR 0.99, 95% CI 0.94-1.04, P= 0.683). This difference in treatment effect between ACE inhibitors and ARBs on all-cause mortality was statistically significant (P-value for heterogeneity 0.036).CONCLUSION:
In patients with hypertension, treatment with an ACE inhibitor results in a significant further reduction in all-cause mortality. Because of the high prevalence of hypertension, the widespread use of ACE inhibitors may result in an important gain in lives saved.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Sistema Renina-Angiotensina
/
Inibidores da Enzima Conversora de Angiotensina
/
Hipertensão
/
Anti-Hipertensivos
Tipo de estudo:
Clinical_trials
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Aged
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Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Eur Heart J
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Holanda