Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension:: the Captopril Prevention Project (CAPPP) randomised trial
Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension:: the Captopril Prevention Project (CAPPP) randomised trial
复制标题
DOI：
10.1016/s0140-6736(98)05012-0
复制
发表时间：
1999-02-20
期刊：
影响因子：
168.9
通讯作者：
Björck, JE
中科院分区：
文献类型：
--
作者：
Hansson, L;Lindholm, LH;Björck, JE
背景 血管紧张素转换酶（ACE）抑制剂已用于治疗高血压十多年，尽管缺乏随机干预试验的数据表明此类治疗会影响心血管发病率和死亡率。卡托普利预防项目 (CAPPP) 是一项随机干预试验，旨在比较 ACE 抑制和常规治疗对高血压患者心血管发病死亡率的影响。方法 CAPPP 是一项前瞻性、随机、开放试验，采用盲法终点评估。瑞典和芬兰的 536 个卫生中心招募了 10 985 名患者。年龄在 25-66 岁、两次测量舒张压达到或超过 100 mm Hg 的患者被随机分配接受卡托普利或常规抗高血压治疗（利尿剂、β 受体阻滞剂）。分析是按意向治疗进行的。主要终点是致命性和非致命性心肌梗塞、中风和其他心血管死亡的复合终点。结果显示，在接受卡托普利治疗的 5492 名患者和接受常规治疗的 5493 名患者中，分别有 14 名和 13 名患者失访。卡托普利组有 363 名患者发生主要终点事件（每 1000 名患者年 11.1 名），常规治疗组有 335 名患者发生主要终点事件（每 1000 名患者年 10.2 名；相对风险 1.05 [95% CI 0.90-1.22]，p = 0.52）。卡托普利的心血管死亡率低于常规治疗（76 例 vs 95 例事件；相对风险 0.77 [0.57-1.04]，p = 0.092），致命性和非致命性心肌梗死发生率相似（162 vs 161），但卡托普利的致命性和非致命性卒中更常见（189 vs 148；1.25） [1.01-1.55]。p = 0.044）。解释卡托普利和常规治疗在预防心血管发病和死亡方面的功效没有差异。中风风险的差异可能是由于随机接受常规治疗的既往治疗患者最初获得的血压水平较低。
Background 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 mortality in patients with hypertension.Methods 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, beta-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.Findings 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% CI 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).Interpretation 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.