Volume 1, Number 2, June 2000

ACE inhibitors in hypertension: Still a shortage of evidence
Peter Sever

Two studies have recently been reported comparing angiotensin-converting enzyme inhibitor (ACE-I)-based treatment with older drugs in hypertensive patients. The hypothesis being tested was that newer drugs would confer a benefit (25% relative risk reduction in total cardiovascular events) compared with other drugs. In retrospect, these objectives were unrealistic based on observations from earlier meta-analyses.
In the event, neither trial demonstrated any clear advantages of ACE-I over treatment with older drugs. Larger trials, such as The Anglo Scandinavian Cardiac Outcomes Trial (ASCOT) and Antihypertensive and the Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT), will address the question of whether newer treatment regimens reduce coronary heart disease (CHD) risk compared with older drugs and further meta-analyses, such as that reported by the Hypertension Triallists' Collaboration, may shed further insight into this important question.

JRAAS 2000;1:117-118.

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