Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials

@article{Neal2000EffectsOA,
  title={Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials},
  author={Bruce Neal and Stephen MacMahon and Neil Chapman},
  journal={The Lancet},
  year={2000},
  volume={356},
  pages={1955-1964}
}
ACE inhibitor-based blood pressure lowering - first line therapy among individuals with hypertension?
TLDR
Evidence about the clinical effects of ACE inhibitors in hypertensive patients was largely restricted to information about intermediate outcomes such as blood pressure and surrogate endpoints such as renal function and left ventricular hypertrophy.
Prospectively designed overviews of recent trials comparing antihypertensive regimens based on different drug classes
TLDR
These overviews of randomized trials of Blood Pressure Lowering Treatment Trialists’ Collaboration found no differences between the effects of regimens based on angiotensin converting enzyme inhibitors and those based on diuretics or b-blockers.
The differences between ACE inhibitor-treated and calcium channel blocker-treated hypertensive patients.
  • G. Mcinnes
  • Medicine
    Journal of clinical hypertension
  • 2003
TLDR
It can be concluded that the use of CCBs in the routine therapy of hypertension cannot be recommended while wider use of ACE inhibitors, along with low-dose diuretics and beta blockers, appears justified.
The effects of calcium channel blockers on cardiovascular outcomes: a review of randomised controlled trials.
TLDR
The available evidence supports the use of these long-acting CCBs such as nifedipine, administered in a gastro-intestinal-transport-system (GITS) formulation, nitrendipine and diltiazem as a first-line treatment option in hypertensive patients.
The Effects of Calcium Channel Blockers on Cardiovascular Outcomes: a Review of Randomised Controlled Trials
TLDR
The available evidence supports the use of these long-acting CCBs such as nifedipine, administered in a gastro-intestinal-transport-system (GITS) formulation, nitrendipine and diltiazem as a first-line treatment option in hypertensive patients.
Conventional therapy and newer drug classes for cardiovascular protection in hypertension.
TLDR
It was found that conventional therapy and newer drug classes had similar long-term efficacy in preventing cardiovascular complications of hypertension, and BP lowering largely accounted for most, if not all, of the observed benefits in cardiovascular outcome.
What can be expected from optimal blood pressure control?
TLDR
Blood pressure gradients accounted for most, if not all, of the differences in outcome in patients with hypertension or at high cardiovascular risk, and showed that antihypertensive drug treatment starting with the dihydropyridine calcium channel blocker, nitrendipine, reduced the risk of stroke and all cardiovascular complications.
The INSIGHT and NORDIL trials: Are calcium antagonists equivalent to established drug therapies for cardiovascular protection?
  • M. Ruddy
  • Medicine
    Current hypertension reports
  • 2001
TLDR
Results of the NORDIL and INSIGHT studies support incorporating calcium antagonist-based therapy as an additional safe and effective approach for preventing blood pressure-related illness and death.
Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials
TLDR
Combination low dose drug treatment increases efficacy and reduces adverse effects and three drugs at half standard dose are estimated to lower blood pressure and thereby reduce the risk of stroke by 63% and ischaemic heart disease events by 46% at age 60-69.
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References

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TLDR
Total mortality and hospitalization for congestive heart failure are significantly reduced by ACE inhibitors with consistent effects in a broad range of patients.
Protocol for prospective collaborative overviews of major randomized trials of blood-pressure-lowering treatments. World Health Organization-International Society of Hypertension Blood Pressure Lowering Treatment Trialists' Collaboration.
TLDR
The combination of trial results in prospectively planned, systematic overviews both reduces random errors and avoids biases and should provide more reliable information about the effects of newer blood-pressure-lowering drugs than would any one study alone.
Effects of ACE Inhibitors on Mortality When Started in the Early Phase of Myocardial Infarction: Evidence from the Larger Randomized Controlled Trials
TLDR
These results demonstrate that for a wide range of patients without clear contraindications, angiotensin converting enzyme inhibitors started early in acute myocardial infarction prevent further deaths in the first few weeks when added to standard therapy (aspirin, thrombolytic therapy and beta-blockers).
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TLDR
Until the results of large long-term clinical trials evaluating the effects of calcium channel blockers and ACE inhibitors on cardiovascular disease incidence are completed, the available scientific evidence provides strong support for the current national guidelines, which recommend diuretics and beta-blockers as firstline agents and low-dose therapy for all antihypertensive agents.
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TLDR
Calcium channel blockers do not reduce the risk of initial or recurrent infarct or death when given routinely to patients with acute myocardial infarction or unstable angina.
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TLDR
Antihypertensive treatment based on a beta-blocker or on a thiazide diuretic could not be shown to affect the prevention of hypertensive complications, including CHD, to a different extent.
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TLDR
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TLDR
Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.
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