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

Journal of Geriatric Cardiology 2012年第3期9卷 252-257页

作者： Cong Ma Jian Cao Xue-Chun Lu Xin-Hong Guo Yan Gao Xian-Feng Liu Li Fan The First Department of Geriatric Cardiology South Building Chinese PLA General Hospital 28 Fuxing Road Beij'ing 100853 China Geriatric Department of Hematology South Building Chinese PLA General Hospital 28 Fuxing Road Beij'ing 100853 China The Institute of Geriatric Cardiology Chinese PLA General Hospital 28 Fuxing Road Beo'ing 100853 China

Background Although angiotensin converting enzyme inhibitors （ACEI） and angiotensin receptor blockers （ARB） are equally important in the treatment of hypertension, there is less evidence whether they have equal cardiovascular and cerebrovascular protective effects, especially in elder hypertensive patients. This study aims to clarify this unresolved issue. Methods This cross-sectional study included clinical data on 933 aged male patients with hypertension who received either an ARB or ACEI for more than two months between January 2007 and May 2011. The primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary endpoints were unstable angina, new atrial fibrillation, and transient ischemic attack. Results The median follow-up time was 24 months. Age, drug types, cerebral infarction history, renal dysfunction history were the independent predictors of the primary endpoint. The risk of an occurrence of a primary endpoint event was higher in the ARB group than the ACEI group [P = 0.037, hazard ratios （HR）： 2.124, 95% confidence interval （95% CI）： 1.048-4.306]. The Kaplan-Meier method also suggests that the rate of primary endpoint occurrence was higher in the ARB group than the ACEI group （P = 0.04）. In regard to the secondary endpoints, there were no significant differences between the two treatment arms （P = 0.137, HR： 1.454, 95% CI： 0.888-2.380）. Patient age and coronary heart disease history were independent predictors of the secondary endpoint. Conclusion ACEI were more effective than ARB in reducing cardiovascular and cerebrovascular morbidity and mortality in aged patients with hypertension.

关键词： Angiotensin receptor blocker Angiotensin converting enzyme inhibitor Renin-angiotensin-aldosterone system angiotensintype 2 receptor

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