Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen - A subanalysis of the Captopril Prevention Project

OBJECTIVE - The Captopril Prevention Project (CAPPP) evaluated the effects of an ACE inhibitor-based therapeutic regimen on cardiovascular mortality a nd morbidity in hypertension. one planned subanalysis of the CAPPP was to e valuate the outcome in the diabetic patient group. RESEARCH DESIGN AND METHODS - In the CAPPP, 572 (4.9% of 10,985 hypertensiv e patients) had diabetes at baseline and were studied according to a prospe ctive, randomized, open, blinded, end point trial design. Patients aged 25- 66 years with diastolic blood pressure greater than or equal to 100 mmHg we re included and randomized to receive either captopril or conventional anti hypertensive treatment (diuretics and/or beta -blockers). RESULTS - The primary end point, fatal and nonfatal myocardial infarction a nd stroke as well as other cardiovascular deaths, was markedly lower in the captopril than in the conventional therapy group (relative risk [RR] = 0.5 9 P = 0.018). Specifically, cardiovascular mortality. defined as fatal stro ke and myocardial infarction, sudden death, and other cardiovascular death tended to be lower in the captopril group (RR = 0.48; P = 0.084), and no di fference was observed between the study groups for stroke (RR = 1.02 P = 0. 96). Myocardial infarctions were less frequent in the captopril group than in the conventional therapy group (RR = 0.34 P = 0.002). Furthermore, total mortality was lower in the captopril as compared with the conventional the rapy group (RR = 0.54; P = 0.034). Patients with impaired metabolic control seemed to benefit the most from ACE inhibitor-based therapy. CONCLUSIONS - Captopril is superior to a diuretic/beta -blocker antihyperte nsive treatment regimen in preventing cardiovascular events in hypertensive diabetic patients, especially in those with metabolic decompensation.