Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial
Angiotensin-converting-enzyme (ACE) inhibitors have been used for more than a decade to treat high blood pressure, despite the lack of data from randomised intervention trials to show that such treatment affects cardiovascular morbidity and mortality. The Captopril Prevention Project (CAPPP) is a ra...
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| Veröffentlicht in: | The Lancet (British edition) 1999-02, Vol.353 (9153), p.611-616 |
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| creator | Hansson, Lennart Lindholm, Lars H Niskanen, Leo Lanke, Jan Hedner, Thomas Niklason, Anders Luomanmäki, Kimmo Dahlöf, Björn de Faire, Ulf Mörlin, Claes Karlberg, Bengt E Wester, PO Björck, Jan-Erik |
| description | Angiotensin-converting-enzyme (ACE) inhibitors have been used for more than a decade to treat high blood pressure, despite the lack of data from randomised intervention trials to show that such treatment affects cardiovascular morbidity and mortality. The Captopril Prevention Project (CAPPP) is a randomised intervention trial to compare the effects of ACE inhibition and conventional therapy on cardiovascular morbidity and mortality in patients with hypertension.
CAPPP was a prospective, randomised, open trial with blinded endpoint evaluation. 10 985 patients were enrolled at 536 health centres in Sweden and Finland. Patients aged 25–66 years with a measured diastolic blood pressure of 100 mm Hg or more on two occasions were randomly assigned captopril or conventional antihypertensive treatment (diuretics, β-blockers). Analysis was by intention-to-treat. The primary endpoint was a composite of fatal and non-fatal myocardial infarction, stroke, and other cardiovascular deaths.
Of 5492 patients assigned captopril and 5493 assigned conventional therapy, 14 and 13, respectively, were lost to follow-up. Primary endpoint events occurred in 363 patients in the captopril group (11·1 per 1000 patient-years) and 335 in the conventional-treatment group (10·2 per 1000 patient-years; relative risk 1·05 [95% Cl 0·90–1·22], p=0·52). Cardiovascular mortality was lower with captopril than with conventional treatment (76
vs 95 events; relative risk 0·77 [0·57–1·04], p=0·092), the rate of fatal and non-fatal myocardial infarction was similar (162
vs 161), but fatal and non-fatal stroke was more common with captopril (189 vs 148; 1·25 [1·01–1·55]. p=0·044).
Captopril and conventional treatment did not differ in efficacy in preventing cardiovascular morbidity and mortality. The difference in stroke risk is probably due to the lower levels of blood pressure obtained initially in previously treated patients randomised to conventional therapy. |
| doi_str_mv | 10.1016/S0140-6736(98)05012-0 |
| format | Article |
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CAPPP was a prospective, randomised, open trial with blinded endpoint evaluation. 10 985 patients were enrolled at 536 health centres in Sweden and Finland. Patients aged 25–66 years with a measured diastolic blood pressure of 100 mm Hg or more on two occasions were randomly assigned captopril or conventional antihypertensive treatment (diuretics, β-blockers). Analysis was by intention-to-treat. The primary endpoint was a composite of fatal and non-fatal myocardial infarction, stroke, and other cardiovascular deaths.
Of 5492 patients assigned captopril and 5493 assigned conventional therapy, 14 and 13, respectively, were lost to follow-up. Primary endpoint events occurred in 363 patients in the captopril group (11·1 per 1000 patient-years) and 335 in the conventional-treatment group (10·2 per 1000 patient-years; relative risk 1·05 [95% Cl 0·90–1·22], p=0·52). Cardiovascular mortality was lower with captopril than with conventional treatment (76
vs 95 events; relative risk 0·77 [0·57–1·04], p=0·092), the rate of fatal and non-fatal myocardial infarction was similar (162
vs 161), but fatal and non-fatal stroke was more common with captopril (189 vs 148; 1·25 [1·01–1·55]. p=0·044).
Captopril and conventional treatment did not differ in efficacy in preventing cardiovascular morbidity and mortality. The difference in stroke risk is probably due to the lower levels of blood pressure obtained initially in previously treated patients randomised to conventional therapy.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(98)05012-0</identifier><identifier>PMID: 10030325</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Adult ; Aged ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Antihypertensive agents ; Antihypertensive Agents - therapeutic use ; Biological and medical sciences ; Blood pressure ; Blood Pressure - drug effects ; Captopril - therapeutic use ; Cardiovascular disease ; Cardiovascular system ; Cause of Death ; Cerebrovascular Disorders - etiology ; Cerebrovascular Disorders - prevention & control ; Confidence Intervals ; Diuretics - therapeutic use ; Drug therapy ; Female ; Follow-Up Studies ; Health risk assessment ; Health risks ; Heart Diseases - etiology ; Heart Diseases - prevention & control ; Humans ; Hypertension ; Hypertension - drug therapy ; Male ; Medical sciences ; Medicin och hälsovetenskap ; Middle Aged ; Morbidity ; Mortality ; Myocardial infarction ; Myocardial Infarction - etiology ; Myocardial Infarction - prevention & control ; Pharmacology. Drug treatments ; Prevention ; Prospective Studies ; Risk Factors ; Survival Rate</subject><ispartof>The Lancet (British edition), 1999-02, Vol.353 (9153), p.611-616</ispartof><rights>1999 Elsevier Ltd</rights><rights>1999 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Feb 20, 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c555t-c0fc06a2d2b0ecd321059a5da44baf7616f0fd546ce6e9c5977d8f8d7ebbd7c63</citedby><cites>FETCH-LOGICAL-c555t-c0fc06a2d2b0ecd321059a5da44baf7616f0fd546ce6e9c5977d8f8d7ebbd7c63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/198984391?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1698321$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10030325$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:1959043$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Hansson, Lennart</creatorcontrib><creatorcontrib>Lindholm, Lars H</creatorcontrib><creatorcontrib>Niskanen, Leo</creatorcontrib><creatorcontrib>Lanke, Jan</creatorcontrib><creatorcontrib>Hedner, Thomas</creatorcontrib><creatorcontrib>Niklason, Anders</creatorcontrib><creatorcontrib>Luomanmäki, Kimmo</creatorcontrib><creatorcontrib>Dahlöf, Björn</creatorcontrib><creatorcontrib>de Faire, Ulf</creatorcontrib><creatorcontrib>Mörlin, Claes</creatorcontrib><creatorcontrib>Karlberg, Bengt E</creatorcontrib><creatorcontrib>Wester, PO</creatorcontrib><creatorcontrib>Björck, Jan-Erik</creatorcontrib><creatorcontrib>for the Captopril Prevention Project (CAPPP) study group</creatorcontrib><title>Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Angiotensin-converting-enzyme (ACE) inhibitors have been used for more than a decade to treat high blood pressure, despite the lack of data from randomised intervention trials to show that such treatment affects cardiovascular morbidity and mortality. The Captopril Prevention Project (CAPPP) is a randomised intervention trial to compare the effects of ACE inhibition and conventional therapy on cardiovascular morbidity and mortality in patients with hypertension.
CAPPP was a prospective, randomised, open trial with blinded endpoint evaluation. 10 985 patients were enrolled at 536 health centres in Sweden and Finland. Patients aged 25–66 years with a measured diastolic blood pressure of 100 mm Hg or more on two occasions were randomly assigned captopril or conventional antihypertensive treatment (diuretics, β-blockers). Analysis was by intention-to-treat. The primary endpoint was a composite of fatal and non-fatal myocardial infarction, stroke, and other cardiovascular deaths.
Of 5492 patients assigned captopril and 5493 assigned conventional therapy, 14 and 13, respectively, were lost to follow-up. Primary endpoint events occurred in 363 patients in the captopril group (11·1 per 1000 patient-years) and 335 in the conventional-treatment group (10·2 per 1000 patient-years; relative risk 1·05 [95% Cl 0·90–1·22], p=0·52). Cardiovascular mortality was lower with captopril than with conventional treatment (76
vs 95 events; relative risk 0·77 [0·57–1·04], p=0·092), the rate of fatal and non-fatal myocardial infarction was similar (162
vs 161), but fatal and non-fatal stroke was more common with captopril (189 vs 148; 1·25 [1·01–1·55]. p=0·044).
Captopril and conventional treatment did not differ in efficacy in preventing cardiovascular morbidity and mortality. The difference in stroke risk is probably due to the lower levels of blood pressure obtained initially in previously treated patients randomised to conventional therapy.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Antihypertensive agents</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood pressure</subject><subject>Blood Pressure - drug effects</subject><subject>Captopril - therapeutic use</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular system</subject><subject>Cause of Death</subject><subject>Cerebrovascular Disorders - etiology</subject><subject>Cerebrovascular Disorders - prevention & control</subject><subject>Confidence Intervals</subject><subject>Diuretics - therapeutic use</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Heart Diseases - etiology</subject><subject>Heart Diseases - prevention & control</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - etiology</subject><subject>Myocardial Infarction - prevention & control</subject><subject>Pharmacology. 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Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hansson, Lennart</au><au>Lindholm, Lars H</au><au>Niskanen, Leo</au><au>Lanke, Jan</au><au>Hedner, Thomas</au><au>Niklason, Anders</au><au>Luomanmäki, Kimmo</au><au>Dahlöf, Björn</au><au>de Faire, Ulf</au><au>Mörlin, Claes</au><au>Karlberg, Bengt E</au><au>Wester, PO</au><au>Björck, Jan-Erik</au><aucorp>for the Captopril Prevention Project (CAPPP) study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>1999-02-20</date><risdate>1999</risdate><volume>353</volume><issue>9153</issue><spage>611</spage><epage>616</epage><pages>611-616</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Angiotensin-converting-enzyme (ACE) inhibitors have been used for more than a decade to treat high blood pressure, despite the lack of data from randomised intervention trials to show that such treatment affects cardiovascular morbidity and mortality. The Captopril Prevention Project (CAPPP) is a randomised intervention trial to compare the effects of ACE inhibition and conventional therapy on cardiovascular morbidity and mortality in patients with hypertension.
CAPPP was a prospective, randomised, open trial with blinded endpoint evaluation. 10 985 patients were enrolled at 536 health centres in Sweden and Finland. Patients aged 25–66 years with a measured diastolic blood pressure of 100 mm Hg or more on two occasions were randomly assigned captopril or conventional antihypertensive treatment (diuretics, β-blockers). Analysis was by intention-to-treat. The primary endpoint was a composite of fatal and non-fatal myocardial infarction, stroke, and other cardiovascular deaths.
Of 5492 patients assigned captopril and 5493 assigned conventional therapy, 14 and 13, respectively, were lost to follow-up. Primary endpoint events occurred in 363 patients in the captopril group (11·1 per 1000 patient-years) and 335 in the conventional-treatment group (10·2 per 1000 patient-years; relative risk 1·05 [95% Cl 0·90–1·22], p=0·52). Cardiovascular mortality was lower with captopril than with conventional treatment (76
vs 95 events; relative risk 0·77 [0·57–1·04], p=0·092), the rate of fatal and non-fatal myocardial infarction was similar (162
vs 161), but fatal and non-fatal stroke was more common with captopril (189 vs 148; 1·25 [1·01–1·55]. p=0·044).
Captopril and conventional treatment did not differ in efficacy in preventing cardiovascular morbidity and mortality. The difference in stroke risk is probably due to the lower levels of blood pressure obtained initially in previously treated patients randomised to conventional therapy.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>10030325</pmid><doi>10.1016/S0140-6736(98)05012-0</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 1999-02, Vol.353 (9153), p.611-616 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_606394 |
| source | MEDLINE; Business Source Complete; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Adrenergic beta-Antagonists - therapeutic use Adult Aged Angiotensin-Converting Enzyme Inhibitors - therapeutic use Antihypertensive agents Antihypertensive Agents - therapeutic use Biological and medical sciences Blood pressure Blood Pressure - drug effects Captopril - therapeutic use Cardiovascular disease Cardiovascular system Cause of Death Cerebrovascular Disorders - etiology Cerebrovascular Disorders - prevention & control Confidence Intervals Diuretics - therapeutic use Drug therapy Female Follow-Up Studies Health risk assessment Health risks Heart Diseases - etiology Heart Diseases - prevention & control Humans Hypertension Hypertension - drug therapy Male Medical sciences Medicin och hälsovetenskap Middle Aged Morbidity Mortality Myocardial infarction Myocardial Infarction - etiology Myocardial Infarction - prevention & control Pharmacology. Drug treatments Prevention Prospective Studies Risk Factors Survival Rate |
| title | Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T17%3A16%3A37IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20angiotensin-converting-enzyme%20inhibition%20compared%20with%20conventional%20therapy%20on%20cardiovascular%20morbidity%20and%20mortality%20in%20hypertension:%20the%20Captopril%20Prevention%20Project%20(CAPPP)%20randomised%20trial&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Hansson,%20Lennart&rft.aucorp=for%20the%20Captopril%20Prevention%20Project%20(CAPPP)%20study%20group&rft.date=1999-02-20&rft.volume=353&rft.issue=9153&rft.spage=611&rft.epage=616&rft.pages=611-616&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(98)05012-0&rft_dat=%3Cproquest_swepu%3E39223704%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=198984391&rft_id=info:pmid/10030325&rft_els_id=S0140673698050120&rfr_iscdi=true |