Key studies of angiotensin converting enzyme ace inhibitors or

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					Table 1
Key studies of angiotensin-converting enzyme (aCe) inhibitors or angiotensin receptor blockers (aRbs) in the treatment of
patients with hypertension or related cardiovascular conditions
Study         Objective                             Patients                           Treatment            Primary End Point          Main Results

HOPE    21    To assess the role of an ACE          9297 high-risk patients who        Ramipril or          Composite of MI,           Ramipril significantly decreased risk for the
              inhibitor in preventing risk for CV   had evidence of vascular           matching placebo.    stroke, or death from      primary end point (P<.001) as well as death
              events in high-risk patients.         disease or diabetes plus 1 other                        CV causes.                 from CV causes (P<.001), MI (P<.001), stroke
                                                    CV risk factor and who were                                                        (P<.001), death from any cause, (P=.005),
                                                    not known to have low ejection                                                     revascularization procedures( P=.002), cardiac
                                                    fraction or HF.                                                                    arrest (P=.02), HF (P<.001), and complications
                                                                                                                                       related to diabetes (P=.03).

 LIFE 22      To establish whether selective        9193 patients with essential       Losartan-based        CV event (death, MI,       Losartan significantly decreased the risk for
              blocking of ANG II with an ARB        hypertension and LVH.              or atenolol-based     or stroke).                the primary end point (P=.021), fatal or nonfatal
              improves LVH beyond reducing                                             antihypertensive                                 stroke (P=.001), and new-onset diabetes
              BP and, consequently, reduces CV                                         treatment.                                       (P=.001) vs atenolol.
              morbidity and death.

 CHARM23      To determine whether use of an        7601 patients in 3 populations:    Candesartan           All-cause mortality.       There was no between-group difference for
              ARB could reduce mortality and        patients with LVEF ≤40% who        or placebo in                                    overall mortality, but candesartan treatment did
              morbidity in patients with CHF.       were or were not receiving an      addition to other                                significantly decrease CV deaths (P=.006) and
                                                    ACE inhibitor, and patients        appropriate                                      hospital admissions for HF (P<.0001).
                                                    with LVEF >40%.                    therapy.

 MOSES24      To determine whether                  1405 high-risk hypertensive        Eprosartan- or        Composite of total         Eprosartan-based treatment was significantly
              eprosartan would be more              patients with a cerebrovascular    nitrendipine-based    mortality and all CV       superior to nitrendipine in decreasing risk for the
              effective than nitrendipine for       event during the last 24           antihypertensive      and cerebrovascular        primary end point (P=.014).
              decreasing cerebrovascular and        months.                            therapy.              events, including all
              CV morbidity and mortality in                                                                  recurrent events.
              hypertensive stroke patients.

 ONTARGET25   To compare the clinical effects       25,620 patients with vascular      Telmisartan,          Composite of death         There was similarity of outcomes among
              of an ARB (telmisartan), an ACE       disease or high-risk diabetes.     ramipril, or the      from CV causes,            groups for the primary outcome measure.
              inhibitor (ramipril), or both in                                         combination.          MI, stroke, or             Combination therapy did result in a higher risk
              patients with vascular disease or                                                              hospitalization for HF.    for hypotensive symptoms (P<.001), syncope
              high-risk diabetes.                                                                                                       (P=.03), and renal dysfunction (P<.001) vs
                                                                                                                                        ramipril alone.

 SCOPE27      To test the hypothesis that the        4964 elderly patients (1518       Candesartan or        Composite of CV            Candesartan was significantly superior to
              ARB candesartan can reduce             with ISH).                        placebo added         death, nonfatal            placebo in decreasing the risk for fatal and
              the risk of stroke in elderly                                            to other agents       stroke, and nonfatal       nonfatal stroke (P=.049).
              patients with ISH.                                                       added as needed       MI.
                                                                                       to control BP.
Table 1

 Study              Objective                           Patients                        Treatment           Primary End Point         Main Results
TRANSCEND30        To determine whether                 5926 patients with CVD or       Telmisartan or     Composite of CV            There was no significant difference between
                   telmisartan would be effective       diabetes with end-organ         placebo.           death, MI, stroke, or      telmisartan and placebo for the primary
                   in patients with CVD or diabetes     damage who were intolerant of                      hospitalization for HF.    outcome. Telmisartan was significantly superior
                   with end-organ damage who            ACE inhibitors.                                                               to placebo in decreasing the unadjusted
                   were intolerant of ACE inhibitors.                                                                                 (P=.048), but not the adjusted (P=.068), risk
                                                                                                                                      for a composite of CV death, MI, or stroke.
                                                                                                                                      Telmisartan also significantly decreased the
                                                                                                                                      risk for CV hospitalization (P=.025).

ACCOMPLISH26       To determine whether the             11,506 patients with            Benazepril plus    Composite of               The benazepril-amlodipine combination
                   combination of an ACE inhibitor      hypertension who were at high   amlodipine or      death from CV              was significantly superior to the benazepril-
                   and a dihydropyridine calcium-       risk for CV events.             hydrochloro-       causes, nonfatal           hydrochlorothiazide combination in decreasing
                   channel blocker would be more                                        thiazide.          MI, nonfatal stroke,       risk for the primary end point (P<.001) and in
                   effective in reducing the rate of                                                       hospitalization for        reducing the risk for the composite of death
                   CV events than treatment with                                                           angina, resuscitation      from CV causes, nonfatal MI, and nonfatal
                   an ACE inhibitor plus a thiazide                                                        after sudden cardiac       stroke (P=.002).
                   diuretic.                                                                               arrest, and coronary

ALLHAT28           To determine whether                 33,357 patients with            Chlorthalidone-,   Composite of fatal         There was no significant difference among
                   treatment with a calcium-            hypertension and at least 1     amlodipine-, or    CHD or nonfatal MI.        treatments for the primary end point. Lisinopril
                   channel blocker or an ACE            other risk factor for CHD.      lisinopril-based                              had higher 6-year rates of combined CVD,
                   inhibitor lowers the incidence                                       antihypertensive                              stroke, and HF than did chlorthalidone.
                   of CHD or other CVD events                                           therapy.                                      Amlodipine had a significantly greater incidence
                   versus treatment with a diuretic.                                                                                  of HF than did either chlorthalidone or lisinopril.

VALUE29            To test the hypothesis that          15,245 patients with treated    Therapy based      Composite of cardiac       There was no significant difference between
                   for the same BP control,             or untreated hypertension and   on valsartan or    mortality and morbidity.   treatments for the primary composite end
                   valsartan would reduce cardiac       high risk of cardiac events.    amlodipine.                                   point.
                   morbidity and mortality more
                   than amlodipine would in
                   hypertensive patients at high
                   CV risk.

aCe, angiotensin-converting enzyme; aNG II, angiotensin II; aRb, angiotensin receptor blocker; bP, blood pressure; CCb, calcium channel blocker; CHD, coronary heart
disease; CHF, chronic heart failure; CV, cardiovascular; CVD, cardiovascular disease; HF, heart failure; ISH, isolated systolic hypertension; lVeF, left ventricular ejection
fraction; lVH, left ventricular hypertrophy; MI, myocardial infarction.
HOPe, Heart Outcomes Prevention evaluation; lIFe, losartan Intervention for endpoint Reduction in Hypertension; CHaRM, Candesartan in Heart Failure assessment of
Reduction in Mortality and Morbidity; MOSeS, Morbidity and Mortality after Stroke, eprosartan Compared With Nitrendipine for Secondary Prevention; ONTaRGeT, Ongo-
ing Telmisartan alone and in Combination with Ramipril Global endpoint Trial; TRaNSCeND, Telmisartan Randomized assessmeNt Study in aCe iNtolerant Subjects with
Cardiovascular Disease; aCCOMPlISH, avoiding Cardiovascular events through Combination Therapy in Patients living with Systolic Hypertension; SCOPe, Study on
Cognition and Prognosis in the elderly; allHaT, antihypertensive and lipid-lowering Treatment to Prevent Heart attack Trial; ValUe, Valsartan antihypertensive long-
term Use evaluation.

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