Studie “ACE-Hemmer und die Verminderung der Sterblichkeit”

Studie “ACE-Hemmer und die Verminderung der Sterblichkeit” (englisch)

Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin–angiotensin–aldosterone system inhibitors involving 158 998 patients von Laura C. van Vark, Michel Bertrand, K. Martijn Akkerhuis, Jasper J. Brugts, Kim Fox, Jean-Jacques Mourad, and Eric Boersma

Aims Renin–angiotensin–aldosterone system (RAAS) inhibitors are well established for the reduction in cardiovascular morbidity, but their impact on all-cause mortality in hypertensive patients is uncertain. Our objective was to
analyse the effects of RAAS inhibitors as a class of drugs, as well as of angiotensin-converting enzyme (ACE) inhibitors and AT1 receptor blockers (ARBs) separately, on all-cause mortality.

Methods and results
We performed a pooled analysis of 20 cardiovascular morbidity–mortality trials. In each trial at least two-thirds of the patients had to be diagnosed with hypertension, according to the trial-specific definition, and randomized to treatment with an RAAS inhibitor or control treatment. The cohort included 158 998 patients (71 401 RAAS inhibitor;87 597 control). The incidence of all-cause death was 20.9 and 23.3 per 1000 patient-years in patients randomized to RAAS inhibition and controls, respectively. Overall, RAAS inhibition was associated with a 5% reduction
in all-cause mortality (HR: 0.95, 95% CI: 0.91–1.00, P ¼ 0.032), and a 7% reduction in cardiovascular mortality (HR: 0.93, 95% CI: 0.88–0.99, P ¼ 0.018).

The observed treatment effect resulted entirely from the class of ACE
inhibitors, which were associated with a significant 10% reduction in all-cause mortality (HR: 0.90, 95% CI: 0.84–0.97, P ¼ 0.004), whereas no mortality reduction could be demonstrated with ARB treatment (HR: 0.99, 95% CI:0.94–1.04, P ¼ 0.683). This difference in treatment effect between ACE inhibitors and ARBs on all-cause mortality was statistically significant (P-value for heterogeneity 0.036).

Conclusion

In patients with hypertension, treatment with an ACE inhibitor results in a significant further reduction in all-cause mortality. Because of the high prevalence of hypertension, the widespread use of ACE inhibitors may result in an
important gain in lives saved.
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Department of Cardiology, Thoraxcenter, Erasmus MC, Gravendijkwal 230, 3015 GE Rotterdam, The Netherlands | Lille Heart Institute, Lille, France | Royal Brompton and National Heart Hospital, London, UK; and Avicenne University Hospital, Bobigny and Paris 13 University, Paris, France

Received 24 August 2011; revised 15 February 2012; accepted 5 March 2012

Reference: Studie "ACE-Hemmer und die Verminderung der Sterblichkeit"