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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... Full description

Journal Title: The Lancet (British edition) 1999, Vol.353 (9153), p.611-616
Main Author: Hansson, Lennart
Other Authors: 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
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: London: Elsevier Ltd
ID: ISSN: 0140-6736
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recordid: cdi_swepub_primary_oai_prod_swepub_kib_ki_se_1959043
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
format: Article
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
subjects:
  • Abridged Index Medicus
  • Adrenergic beta blockers
  • Adrenergic beta-Antagonists - therapeutic use
  • Adult
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors - therapeutic use
  • Antihypertensive agents
  • Antihypertensive Agents - therapeutic use
  • Antihypertensive drugs
  • Biological and medical sciences
  • Blood Pressure - drug effects
  • Captopril
  • Captopril - therapeutic use
  • Cardiovascular disease
  • Cardiovascular system
  • Cause of Death
  • Cerebrovascular Disorders - etiology
  • Cerebrovascular Disorders - prevention & control
  • Confidence Intervals
  • Diuretics
  • Diuretics - therapeutic use
  • Drug therapy
  • Evaluation
  • Female
  • Follow-Up Studies
  • Health risk assessment
  • Heart Diseases - etiology
  • Heart Diseases - prevention & control
  • Humans
  • Hypertension
  • Hypertension - drug therapy
  • Male
  • Medical sciences
  • Medicin och hälsovetenskap
  • Middle Aged
  • Mortality
  • Myocardial Infarction - etiology
  • Myocardial Infarction - prevention & control
  • Pharmacology. Drug treatments
  • Prospective Studies
  • Risk Factors
  • Survival Rate
ispartof: The Lancet (British edition), 1999, Vol.353 (9153), p.611-616
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.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleEffect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial
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creatorHansson, 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
creatorcontribHansson, 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 ; for the Captopril Prevention Project (CAPPP) study group
descriptionAngiotensin-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.
identifier
0ISSN: 0140-6736
1EISSN: 1474-547X
2DOI: 10.1016/S0140-6736(98)05012-0
3PMID: 10030325
4CODEN: LANCAO
languageeng
publisherLondon: Elsevier Ltd
subjectAbridged Index Medicus ; Adrenergic beta blockers ; Adrenergic beta-Antagonists - therapeutic use ; Adult ; Aged ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Antihypertensive agents ; Antihypertensive Agents - therapeutic use ; Antihypertensive drugs ; Biological and medical sciences ; Blood Pressure - drug effects ; Captopril ; Captopril - therapeutic use ; Cardiovascular disease ; Cardiovascular system ; Cause of Death ; Cerebrovascular Disorders - etiology ; Cerebrovascular Disorders - prevention & control ; Confidence Intervals ; Diuretics ; Diuretics - therapeutic use ; Drug therapy ; Evaluation ; Female ; Follow-Up Studies ; Health risk assessment ; Heart Diseases - etiology ; Heart Diseases - prevention & control ; Humans ; Hypertension ; Hypertension - drug therapy ; Male ; Medical sciences ; Medicin och hälsovetenskap ; Middle Aged ; Mortality ; Myocardial Infarction - etiology ; Myocardial Infarction - prevention & control ; Pharmacology. Drug treatments ; Prospective Studies ; Risk Factors ; Survival Rate
ispartofThe Lancet (British edition), 1999, Vol.353 (9153), p.611-616
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1Lindholm, Lars H
2Niskanen, Leo
3Lanke, Jan
4Hedner, Thomas
5Niklason, Anders
6Luomanmäki, Kimmo
7Dahlöf, Björn
8de Faire, Ulf
9Mörlin, Claes
10Karlberg, Bengt E
11Wester, PO
12Björck, Jan-Erik
13for the Captopril Prevention Project (CAPPP) study group
title
0Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial
1The Lancet (British edition)
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descriptionAngiotensin-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.
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1Adrenergic beta blockers
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3Adult
4Aged
5Angiotensin-Converting Enzyme Inhibitors - therapeutic use
6Antihypertensive agents
7Antihypertensive Agents - therapeutic use
8Antihypertensive drugs
9Biological and medical sciences
10Blood Pressure - drug effects
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13Cardiovascular disease
14Cardiovascular system
15Cause of Death
16Cerebrovascular Disorders - etiology
17Cerebrovascular Disorders - prevention & control
18Confidence Intervals
19Diuretics
20Diuretics - therapeutic use
21Drug therapy
22Evaluation
23Female
24Follow-Up Studies
25Health risk assessment
26Heart Diseases - etiology
27Heart Diseases - prevention & control
28Humans
29Hypertension
30Hypertension - drug therapy
31Male
32Medical sciences
33Medicin och hälsovetenskap
34Middle Aged
35Mortality
36Myocardial Infarction - etiology
37Myocardial Infarction - prevention & control
38Pharmacology. Drug treatments
39Prospective Studies
40Risk Factors
41Survival Rate
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titleEffect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial
authorHansson, 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
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38Pharmacology. Drug treatments
39Prospective Studies
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41Survival Rate
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jtitleThe Lancet (British edition)
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abstractAngiotensin-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.
copLondon
pubElsevier Ltd
pmid10030325
doi10.1016/S0140-6736(98)05012-0