Captopril superior to diuretics and beta-blockers in diabetic hypertensive patients

מתוך medicontext.co.il

NEW YORK (Reuters Health) – Among hypertensive diabetic patients, the angiotensin-converting enzyme (ACE) inhibitor, captopril, prevents significantly more cardiovascular events than a regimen of diuretics and beta-blockers, Finnish researchers report in the December issue of Diabetes Care.

Dr. Leo Niskanen from the University of Kuopio, and colleagues performed a subanalysis of data from the Captopril Prevention Trial (CAPPP). In that trial, 10,985 patients with diastolic blood pressure of 100 mmHg or more were randomized to captopril or diuretics and/or beta-blockers, and 572 of the patients were diabetic.

Analysis of the diabetic patients showed that the primary end point of fatal or nonfatal myocardial infarction, stroke, and other cardiovascular deaths was significantly lower among those receiving captopril than for patients on diuretics and/or beta-blockers (relative risk 0.59, p = 0.018).

There were fewer deaths from all causes among those taking captopril compared with those taking diuretics/beta-blockers (relative risk 0.54, p = 0.034). However, there was no difference between the treatment groups in stroke (relative risk 1.02, p = 0.959), Dr. Niskanen's team notes.

Patients with impaired metabolic control appeared to derive the most benefit the captopril regimen, the Finnish group adds.

Dr. Niskanen and colleagues conclude that "analysis of the outcome of the diabetic patient group in the CAPPP showed that the ACE inhibitor is an obvious first-choice drug for hypertensive patients with diabetes, especially when there is metabolic decompensation. However, because elevated blood pressure levels should be aggressively treated in diabetic patients, a multiple drug regimen is commonly required to achieve optimal treatment targets."

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