The Pharmaceutical Journal
Vol 270 No 7243 p468
5 April 2003

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ACE inhibitors are better than calcium channel blockers as first-line therapy

Using angiotensin converting enzyme (ACE) inhibitors rather than calcium channel blockers (CCBs) to treat newly diagnosed hypertension in primary care gives better cardiovascular outcomes, according to research presented at the American College of Cardiology congress in Chicago this week.

Dr Gordon McInnes and a team from the Glasgow Blood Pressure Clinic analysed records from the United Kingdom General Practice Research Database. From a sample of 105,965 treated hypertensive patients, they identified 11,249 who received ACE inhibitors and 12,494 who received CCBs as their first ever therapy between 1988 and 1998 and who did not have cardiovascular disease before treatment. Cardiovascular outcome rates for ACE-inhibitor and CCB treatment during an average of six years follow-up were calculated.

Compared with CCB use, first-line treatment of hypertension with an ACE inhibitor was associated with reductions in cardiovascular outcomes, the researchers found. Relative hazard ratios for coronary artery disease were 0.63 (95 per cent confidence interval 0.58–0.68) and 0.87 (CI 0.78–0.97) for cerebrovascular events. A trend in favour of ACE-inhibitor treatment was also seen for heart failure, relative hazard ratio 0.90 (CI 0.81–1.00).

The research team say that because 25 per cent of patients in each group subsequently received treatment with a drug from the other class, differences may have been underestimated. CCB-treated patients inc-luded more smokers (19 vs 14 per cent) and fewer diabetes patients (13 vs 16 per cent) but the treatment groups were well balanced for other risk factors. Achieved systolic blood pressure was lower (by 1.6mmHg) in ACE-inhibitor-treated patients, whereas diastolic blood pressure was higher (by 1.4mmHg). Adjustment for these imbalances did not alter the hazard ratios.

In conclusion, the researchers say that, compared with CCB treatment, treatment of hypertension with ACE inhibitors in primary care is associated with a lower rate of cardiovascular outcomes. The findings are not easily explained by differences in blood pressure control or other risk factors.

The Pharmaceutical Journal attended the American College of Cardiology congress courtesy of Merck/Schering-Plough Pharmaceuticals