Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomised trials

B. Neal, S. MacMahon, N. Chapman, J. Cutler, R. Fagard, P. Whelton, S. Yusuf, L. Agodoa, C. Baigent, H. Black, J. P. Boissel, B. Brenner, M. Brown, C. Bulpitt, R. Byington, J. Chalmers, R. Collins, B. Dahlof, B. Davis, R. EstacioK. Fox, L. Hansson, R. Holman, L. Hunsicker, J. Kostis, K. Kuramoto, J. Kusek, R. Lees, E. Lewis, L. H. Lindholm, L. Liu, J. Lubsen, E. Malacco, G. Mancia, I. Martin, C. Pepine, M. Pfeffer, B. Pitt, P. Poole-Wilson, G. Remuzzi, A. Rodgers, P. Ruggenenti, R. Schrier, P. Sever, P. Sleight, J. Staessen, K. Teo, R. Turner, L. Wing, A. Zanchetti, C. Algert, M. Woodward

Research output: Contribution to journalArticle

Abstract

Background. This programme of overviews of randomised trials was established to investigate the effects of angiotensin-converting-enzyme (ACE) inhibitors, calcium antagonists, and other blood-pressure-lowering drugs on mortality and major cardiovascular morbidity in several populations of patients. We did separate overviews of trials comparing active treatment regimens with placebo, trials comparing more intensive and less intensive blood-pressure-lowering strategies, and trials comparing treatment regimens based on different drug classes. Methods. The hypotheses to be investigated, the trials to be included, and the outcomes to be studied were all selected before the results of any participating trial were known. Individual participant data or group tabular data were provided by each trial and combined by standard statistical techniques. Findings. The overview of placebo-controlled trials of ACE inhibitors (four trials, 12 124 patients mostly with coronary heart disease) revealed reductions in stroke (30% [95% Cl 15-43]), coronary heart disease (20% [11-28]), and major cardiovascular events (21% [14-27]). The overview of placebo-controlled trials of calcium antagonists (two trials, 5520 patients mostly with hypertension) showed reductions in stroke (39% [15-56]) and major cardiovascular events (28% [13-41]). In the overview of trials comparing blood-pressure-lowering strategies of different intensity (three trials, 20408 patients with hypertension), there were reduced risks of stroke (20% [2-35]), coronary heart disease (19% [2-33]), and major cardiovascular events (15% [4-24]) with more intensive therapy. In the overviews comparing different antihypertensive regimens (eight trials, 37 872 patients with hypertension), several differences in cause-specific effects were seen between calcium-antagonist-based therapy and other regimens, but each was of borderline significance. Interpretation. Strong evidence of benefits of ACE inhibitors and calcium antagonists is provided by the overviews of placebo-controlled trials. There is weaker evidence of differences between treatment regimens of differing intensities and of differences between treatment regimens based on different drug classes. Data from continuing trials of blood-pressure-lowering drugs will substantially increase the evidence available about any real differences that might exist between regimens.

Original languageEnglish
Pages (from-to)1955-1964
Number of pages10
JournalLancet
Volume356
Issue number9246
DOIs
Publication statusPublished - Dec 9 2000

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Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Calcium
Placebos
Pharmaceutical Preparations
Coronary Disease
Stroke
Hypertension
Therapeutics
Antihypertensive Agents
Morbidity
Mortality
Population

ASJC Scopus subject areas

  • Medicine(all)

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Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs : Results of prospectively designed overviews of randomised trials. / Neal, B.; MacMahon, S.; Chapman, N.; Cutler, J.; Fagard, R.; Whelton, P.; Yusuf, S.; Agodoa, L.; Baigent, C.; Black, H.; Boissel, J. P.; Brenner, B.; Brown, M.; Bulpitt, C.; Byington, R.; Chalmers, J.; Collins, R.; Dahlof, B.; Davis, B.; Estacio, R.; Fox, K.; Hansson, L.; Holman, R.; Hunsicker, L.; Kostis, J.; Kuramoto, K.; Kusek, J.; Lees, R.; Lewis, E.; Lindholm, L. H.; Liu, L.; Lubsen, J.; Malacco, E.; Mancia, G.; Martin, I.; Pepine, C.; Pfeffer, M.; Pitt, B.; Poole-Wilson, P.; Remuzzi, G.; Rodgers, A.; Ruggenenti, P.; Schrier, R.; Sever, P.; Sleight, P.; Staessen, J.; Teo, K.; Turner, R.; Wing, L.; Zanchetti, A.; Algert, C.; Woodward, M.

In: Lancet, Vol. 356, No. 9246, 09.12.2000, p. 1955-1964.

Research output: Contribution to journalArticle

Neal, B, MacMahon, S, Chapman, N, Cutler, J, Fagard, R, Whelton, P, Yusuf, S, Agodoa, L, Baigent, C, Black, H, Boissel, JP, Brenner, B, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Collins, R, Dahlof, B, Davis, B, Estacio, R, Fox, K, Hansson, L, Holman, R, Hunsicker, L, Kostis, J, Kuramoto, K, Kusek, J, Lees, R, Lewis, E, Lindholm, LH, Liu, L, Lubsen, J, Malacco, E, Mancia, G, Martin, I, Pepine, C, Pfeffer, M, Pitt, B, Poole-Wilson, P, Remuzzi, G, Rodgers, A, Ruggenenti, P, Schrier, R, Sever, P, Sleight, P, Staessen, J, Teo, K, Turner, R, Wing, L, Zanchetti, A, Algert, C & Woodward, M 2000, 'Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomised trials', Lancet, vol. 356, no. 9246, pp. 1955-1964. https://doi.org/10.1016/S0140-6736(00)03307-9
Neal, B. ; MacMahon, S. ; Chapman, N. ; Cutler, J. ; Fagard, R. ; Whelton, P. ; Yusuf, S. ; Agodoa, L. ; Baigent, C. ; Black, H. ; Boissel, J. P. ; Brenner, B. ; Brown, M. ; Bulpitt, C. ; Byington, R. ; Chalmers, J. ; Collins, R. ; Dahlof, B. ; Davis, B. ; Estacio, R. ; Fox, K. ; Hansson, L. ; Holman, R. ; Hunsicker, L. ; Kostis, J. ; Kuramoto, K. ; Kusek, J. ; Lees, R. ; Lewis, E. ; Lindholm, L. H. ; Liu, L. ; Lubsen, J. ; Malacco, E. ; Mancia, G. ; Martin, I. ; Pepine, C. ; Pfeffer, M. ; Pitt, B. ; Poole-Wilson, P. ; Remuzzi, G. ; Rodgers, A. ; Ruggenenti, P. ; Schrier, R. ; Sever, P. ; Sleight, P. ; Staessen, J. ; Teo, K. ; Turner, R. ; Wing, L. ; Zanchetti, A. ; Algert, C. ; Woodward, M. / Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs : Results of prospectively designed overviews of randomised trials. In: Lancet. 2000 ; Vol. 356, No. 9246. pp. 1955-1964.
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abstract = "Background. This programme of overviews of randomised trials was established to investigate the effects of angiotensin-converting-enzyme (ACE) inhibitors, calcium antagonists, and other blood-pressure-lowering drugs on mortality and major cardiovascular morbidity in several populations of patients. We did separate overviews of trials comparing active treatment regimens with placebo, trials comparing more intensive and less intensive blood-pressure-lowering strategies, and trials comparing treatment regimens based on different drug classes. Methods. The hypotheses to be investigated, the trials to be included, and the outcomes to be studied were all selected before the results of any participating trial were known. Individual participant data or group tabular data were provided by each trial and combined by standard statistical techniques. Findings. The overview of placebo-controlled trials of ACE inhibitors (four trials, 12 124 patients mostly with coronary heart disease) revealed reductions in stroke (30{\%} [95{\%} Cl 15-43]), coronary heart disease (20{\%} [11-28]), and major cardiovascular events (21{\%} [14-27]). The overview of placebo-controlled trials of calcium antagonists (two trials, 5520 patients mostly with hypertension) showed reductions in stroke (39{\%} [15-56]) and major cardiovascular events (28{\%} [13-41]). In the overview of trials comparing blood-pressure-lowering strategies of different intensity (three trials, 20408 patients with hypertension), there were reduced risks of stroke (20{\%} [2-35]), coronary heart disease (19{\%} [2-33]), and major cardiovascular events (15{\%} [4-24]) with more intensive therapy. In the overviews comparing different antihypertensive regimens (eight trials, 37 872 patients with hypertension), several differences in cause-specific effects were seen between calcium-antagonist-based therapy and other regimens, but each was of borderline significance. Interpretation. Strong evidence of benefits of ACE inhibitors and calcium antagonists is provided by the overviews of placebo-controlled trials. There is weaker evidence of differences between treatment regimens of differing intensities and of differences between treatment regimens based on different drug classes. Data from continuing trials of blood-pressure-lowering drugs will substantially increase the evidence available about any real differences that might exist between regimens.",
author = "B. Neal and S. MacMahon and N. Chapman and J. Cutler and R. Fagard and P. Whelton and S. Yusuf and L. Agodoa and C. Baigent and H. Black and Boissel, {J. P.} and B. Brenner and M. Brown and C. Bulpitt and R. Byington and J. Chalmers and R. Collins and B. Dahlof and B. Davis and R. Estacio and K. Fox and L. Hansson and R. Holman and L. Hunsicker and J. Kostis and K. Kuramoto and J. Kusek and R. Lees and E. Lewis and Lindholm, {L. H.} and L. Liu and J. Lubsen and E. Malacco and G. Mancia and I. Martin and C. Pepine and M. Pfeffer and B. Pitt and P. Poole-Wilson and G. Remuzzi and A. Rodgers and P. Ruggenenti and R. Schrier and P. Sever and P. Sleight and J. Staessen and K. Teo and R. Turner and L. Wing and A. Zanchetti and C. Algert and M. Woodward",
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TY - JOUR

T1 - Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs

T2 - Results of prospectively designed overviews of randomised trials

AU - Neal, B.

AU - MacMahon, S.

AU - Chapman, N.

AU - Cutler, J.

AU - Fagard, R.

AU - Whelton, P.

AU - Yusuf, S.

AU - Agodoa, L.

AU - Baigent, C.

AU - Black, H.

AU - Boissel, J. P.

AU - Brenner, B.

AU - Brown, M.

AU - Bulpitt, C.

AU - Byington, R.

AU - Chalmers, J.

AU - Collins, R.

AU - Dahlof, B.

AU - Davis, B.

AU - Estacio, R.

AU - Fox, K.

AU - Hansson, L.

AU - Holman, R.

AU - Hunsicker, L.

AU - Kostis, J.

AU - Kuramoto, K.

AU - Kusek, J.

AU - Lees, R.

AU - Lewis, E.

AU - Lindholm, L. H.

AU - Liu, L.

AU - Lubsen, J.

AU - Malacco, E.

AU - Mancia, G.

AU - Martin, I.

AU - Pepine, C.

AU - Pfeffer, M.

AU - Pitt, B.

AU - Poole-Wilson, P.

AU - Remuzzi, G.

AU - Rodgers, A.

AU - Ruggenenti, P.

AU - Schrier, R.

AU - Sever, P.

AU - Sleight, P.

AU - Staessen, J.

AU - Teo, K.

AU - Turner, R.

AU - Wing, L.

AU - Zanchetti, A.

AU - Algert, C.

AU - Woodward, M.

PY - 2000/12/9

Y1 - 2000/12/9

N2 - Background. This programme of overviews of randomised trials was established to investigate the effects of angiotensin-converting-enzyme (ACE) inhibitors, calcium antagonists, and other blood-pressure-lowering drugs on mortality and major cardiovascular morbidity in several populations of patients. We did separate overviews of trials comparing active treatment regimens with placebo, trials comparing more intensive and less intensive blood-pressure-lowering strategies, and trials comparing treatment regimens based on different drug classes. Methods. The hypotheses to be investigated, the trials to be included, and the outcomes to be studied were all selected before the results of any participating trial were known. Individual participant data or group tabular data were provided by each trial and combined by standard statistical techniques. Findings. The overview of placebo-controlled trials of ACE inhibitors (four trials, 12 124 patients mostly with coronary heart disease) revealed reductions in stroke (30% [95% Cl 15-43]), coronary heart disease (20% [11-28]), and major cardiovascular events (21% [14-27]). The overview of placebo-controlled trials of calcium antagonists (two trials, 5520 patients mostly with hypertension) showed reductions in stroke (39% [15-56]) and major cardiovascular events (28% [13-41]). In the overview of trials comparing blood-pressure-lowering strategies of different intensity (three trials, 20408 patients with hypertension), there were reduced risks of stroke (20% [2-35]), coronary heart disease (19% [2-33]), and major cardiovascular events (15% [4-24]) with more intensive therapy. In the overviews comparing different antihypertensive regimens (eight trials, 37 872 patients with hypertension), several differences in cause-specific effects were seen between calcium-antagonist-based therapy and other regimens, but each was of borderline significance. Interpretation. Strong evidence of benefits of ACE inhibitors and calcium antagonists is provided by the overviews of placebo-controlled trials. There is weaker evidence of differences between treatment regimens of differing intensities and of differences between treatment regimens based on different drug classes. Data from continuing trials of blood-pressure-lowering drugs will substantially increase the evidence available about any real differences that might exist between regimens.

AB - Background. This programme of overviews of randomised trials was established to investigate the effects of angiotensin-converting-enzyme (ACE) inhibitors, calcium antagonists, and other blood-pressure-lowering drugs on mortality and major cardiovascular morbidity in several populations of patients. We did separate overviews of trials comparing active treatment regimens with placebo, trials comparing more intensive and less intensive blood-pressure-lowering strategies, and trials comparing treatment regimens based on different drug classes. Methods. The hypotheses to be investigated, the trials to be included, and the outcomes to be studied were all selected before the results of any participating trial were known. Individual participant data or group tabular data were provided by each trial and combined by standard statistical techniques. Findings. The overview of placebo-controlled trials of ACE inhibitors (four trials, 12 124 patients mostly with coronary heart disease) revealed reductions in stroke (30% [95% Cl 15-43]), coronary heart disease (20% [11-28]), and major cardiovascular events (21% [14-27]). The overview of placebo-controlled trials of calcium antagonists (two trials, 5520 patients mostly with hypertension) showed reductions in stroke (39% [15-56]) and major cardiovascular events (28% [13-41]). In the overview of trials comparing blood-pressure-lowering strategies of different intensity (three trials, 20408 patients with hypertension), there were reduced risks of stroke (20% [2-35]), coronary heart disease (19% [2-33]), and major cardiovascular events (15% [4-24]) with more intensive therapy. In the overviews comparing different antihypertensive regimens (eight trials, 37 872 patients with hypertension), several differences in cause-specific effects were seen between calcium-antagonist-based therapy and other regimens, but each was of borderline significance. Interpretation. Strong evidence of benefits of ACE inhibitors and calcium antagonists is provided by the overviews of placebo-controlled trials. There is weaker evidence of differences between treatment regimens of differing intensities and of differences between treatment regimens based on different drug classes. Data from continuing trials of blood-pressure-lowering drugs will substantially increase the evidence available about any real differences that might exist between regimens.

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JO - The Lancet

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