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#14
Reduced Cardiovascular Morbidity and
Mortality in Hypertensive Diabetic Patients
Captopril is superior to a
diuretic/ß-blocker antihypertensive treatment
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 ß-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/ß-blocker antihypertensive treatment regimen in
preventing cardiovascular events in hypertensive diabetic
patients, especially in those with metabolic decompensation. A
subanalysis of the Captopril Prevention Project
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FACT:
Diabetes Will Use Up a Fifth of
the British National Health Budget by 2010.
That’s according to leading
researchers into the disease, who predict that by then it will
affect more than 3 million adults in Brit
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