What question did this study set out to answer?

To evaluate the impact of an ACE inhibitor-based regimen on cardiovascular morbidity and mortality in hypertensive patients with diabetes.

December 1, 2001Diabetes CareOpen Access

Reduced Cardiovascular Morbidity and Mortality in Hypertensive Diabetic Patients on First-Line Therapy With an ACE Inhibitor Compared With a Diuretic/β-Blocker–Based Treatment Regimen

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Favors ACE inhibitor first-line therapy in hypertensive diabetes; leaves open confirmation in modern dedicated trials.

To evaluate the impact of an ACE inhibitor-based regimen on cardiovascular morbidity and mortality in hypertensive patients with diabetes.
Conducted a planned subanalysis of the prospective, randomized, open-label, blinded-endpoint Captopril Prevention Project (CAPPP).
Enrolled 572 hypertensive diabetic patients (aged 25–66 years, diastolic blood pressure ≥100 mmHg) randomly assigned to captopril or conventional therapy with diuretics and/or beta-blockers.
The primary endpoint of fatal and nonfatal myocardial infarction, stroke, and other cardiovascular deaths was significantly lower in the captopril group compared with conventional therapy (RR = 0.59; P = 0.018).
Captopril significantly reduced myocardial infarction (RR = 0.34; P = 0.002) and total mortality (RR = 0.54; P = 0.034), whereas stroke incidence was unchanged between groups (RR = 1.02; P = 0.96).
Cardiovascular mortality tended to be lower with captopril (RR = 0.48; P = 0.084), with the greatest clinical benefit observed in patients exhibiting poor metabolic control.

Niskanen et al. (2001) studied this question.

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