ACE inhibitors are better than diuretics for treatment of hypertension in the elderly

Q&A

J Fam Pract. 2003 June;52(6):431-454

By

BACKGROUND: The recent ALLHAT study compared the diuretic chlorthalidone with the ACE inhibitor lisinopril and the calcium-channel blocker amlodipine for treating hypertension in patients aged 55 years and older who had at least 1 other coronary heart disease risk factor.¹
POPULATION STUDIED: A total of 6083 subjects with hypertension, aged 65 to 84 years and mostly of European ancestry, were enrolled from 1594 family medical practices throughout Australia. Hypertension was defined as an average of 2 systolic blood pressure readings of at least 160 mm Hg, or an average diastolic blood pressure of at least 90 mm Hg with a systolic blood pressure of at least 140 mm Hg.
STUDY DESIGN AND VALIDITY: In this randomized, nonblinded study, subjects were followed for a median of 4.1 years, with a blinded assessment of endpoints. Allocation was concealed. Previous antihypertensive drug therapy was discontinued at least 1 week prior to entry.
OUTCOMES MEASURED: The primary endpoint was the combined rate of all cardiovascular events or death from any cause. Investigators also measured blood pressure and cause-specific cardiovascular events (fatal and nonfatal).
RESULTS: By the study’s end, approximately 60% of the subjects were still receiving their assigned treatment. Sixty-five percent of the ACE inhibitor group and 67% of the diuretic group were receiving monotherapy. The reduction of blood pressure was similar in both groups.

Recommended Reading