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The Pharmaceutical Journal Vol 264 No 7089 p460
March 25, 2000 Clinical

ACE inhibitors "first choice" for hypertension, expert says

A mortality study in patients with hypertension has shown that angiotensin converting enzyme (ACE) inhibitors have benefits over calcium channel blockers. Results from the study of 5,207 patients who had attended the Glasgow blood pressure clinic over a 16-year period showed that ACE inhibitors have consistently high protective effects, while calcium channel blockers have survival disadvantages to patients. The study concluded that beta-blockers and diuretics had an intermediate effect on risk of all cause mortality, death from ischaemic heart disease and vascular deaths.
Presenting the results at the Annual American College of Cardiology conference on March 15, Dr Gordon McInnes (senior lecturer in medicines and therapeutics, University of Glasgow) said that the study supported ACE inhibitors as the "first choice" for treating high blood pressure and related conditions. "Calcium channel blockers should only be considered after exhausting all other treatment options," he said.

blood pressure
Calcium channel blockers should only be considered after all other treatment options for hypertension, research suggests

In the study, ACE inhibitors reduced all-cause mortality by 25 per cent and calcium channel blockers increased risk of death by one-third compared with a control group. ACE inhibitors also reduced the risk of death from coronary artery disease and from all vascular mortality whereas calcium channel blockers increased risk in both cases.
Four groups were identified in the study - patients who had only had an ACE inhibitor, patients who had only had a calcium channel blocker, patients who had received both and patients who had not received either drug (control group). Patients in the control group were treated with other drugs, usually diuretics and beta-blockers.
Dr Gregory Lip (consultant cardiologist, City hospital, Birmingham) told The Journal on March 22 that the study added to current available information. While the data were "reasonable", it had to be recognised that the study was not a prospective randomised controlled trial, he said.