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Cardiovascular and cerebrovascular outcomes in elderly hypertensive patients treated with either ARB or ACEI

Cong Ma1, Jian Cao, Xue-Chun Lu

  • 1The First Department of Geriatric Cardiology, South Building, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.

Journal of Geriatric Cardiology : JGC
|October 26, 2012
PubMed

Insights

Angiotensin converting enzyme inhibitors (ACEI) demonstrated superior cardiovascular and cerebrovascular protection compared to angiotensin receptor blockers (ARB) in elderly hypertensive men. This finding suggests ACEI may be preferred for reducing adverse events in this population.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Hypertension management often involves ACEI and ARB.
  • Limited evidence exists on comparative cardiovascular and cerebrovascular protective effects in elderly hypertensive patients.
  • This study addresses the comparative efficacy of ACEI versus ARB in this demographic.

Purpose of the Study:

  • To compare the cardiovascular and cerebrovascular protective effects of ACEI and ARB in aged male hypertensive patients.
  • To determine if ACEI and ARB offer equivalent protection against major adverse cardiovascular and cerebrovascular events.
  • To identify predictors of primary and secondary endpoints in this patient group.

Main Methods:

  • A cross-sectional study analyzed data from 933 elderly male hypertensive patients.
  • Patients received either ARB or ACEI for over two months.
  • Primary outcome: composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary endpoints included unstable angina, new atrial fibrillation, and transient ischemic attack.

Main Results:

  • The ACEI group showed a significantly lower risk of primary endpoint events compared to the ARB group (P=0.037).
  • Kaplan-Meier analysis confirmed a higher rate of primary endpoint occurrence in the ARB group (P=0.04).
  • No significant differences were observed between ACEI and ARB for secondary endpoints (P=0.137).

Conclusions:

  • ACEI were found to be more effective than ARB in reducing cardiovascular and cerebrovascular morbidity and mortality in aged hypertensive patients.
  • Patient age and history of coronary heart disease were independent predictors of secondary endpoints.
  • These findings suggest a potential preference for ACEI in this specific patient population for enhanced protection.
Abstract

Keywords:
Angiotensin converting enzyme inhibitorAngiotensin receptor blockerAngiotensin type 2 receptorRenin-angiotensin-aldosterone system

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