ACE inhibitor and amlodipine combo efficacious in patients with diabetes and hypertension
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An ACE inhibitor when combined with amlodipine was more effective in preventing fatal and nonfatal CV outcomes in patients with hypertension and diabetes than when combined with hydrochlorothiazide, study data indicated.
Researchers analyzed patients with diabetes (n=6,946) who were randomly assigned to treatment with benazepril combined with either amlodipine (B+A) or hydrochlorothiazide (B+H) in the ACCOMPLISH trial. They also analyzed a subgroup of patients with diabetes at a very high risk (n=2,842) and patients without diabetes (n=4,559). A composite of CV death, stroke, MI, resuscitated arrest, hospitalization for angina and coronary revascularization was the primary endpoint.
The mean achieved BP in the full diabetes group was 131.5 mm Hg/72.6 mm Hg in the B+A treatment group and 132.7 mm Hg/73.7 mm Hg in the B+H group. During 30 months, the B+A group experienced 307 primary events while the B+H group had 383 (HR=0.79; 95% CI, 0.68-0.92). The patients with a very high risk of diabetes given B+A had 195 primary events, whereas those given B+H had 244 (HR=0.77; 95% CI, 0.64-0.93). In patients without diabetes, there were 245 primary events in the B+A group and 296 in the B+H group (HR=0.82; 95% CI, 0.69-0.97).
“For the large proportion of diabetic patients whose blood pressure can be controlled with a two-drug combination, the use of amlodipine with a blocker of the renin-angiotensin system should now be considered,” the researchers concluded.
Weber M. J Am Coll Cardiol. 2010;doi:10.1016/j.jacc.2010.02.046.
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No improvement on all-cause mortality in patients given statins
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Patients at high risk who received statins showed no evidence of all-cause mortality improvement, study data indicated.
Researchers of this meta-analysis compiled trials through searches of the Medline and Cochrane databases that were dated January 1970 to May 2009, using terms related to statins, CV endpoints and clinical trials. The prospective, randomized controlled trials of statin therapy involved patients free from CVD at baseline and provided data on all-cause mortality.
In the 11 selected trials (n=65,229), patients were followed for about 244,000 person-years. During this time, 2,793 deaths took place, of which 1,447 deaths occurred among placebo patients (n=32,606) and 1,346 deaths among those treated with a statin (n=32,623). The RR for all-cause mortality associated with statin use was 0.91 (95% CI, 0.83-1.01). Researchers also reported no statistical evidence of heterogeneity between the studies (I²=23%; 95% CI, 0%-61%).
“We observed that statin therapy for an average period of 3.7 years had no benefit on all-cause mortality in a high-risk primary prevention population,” the researchers wrote. “Current prevention guidelines endorse statin therapy for subjects at high global risk of incident CVD as a means to reduce fatal and nonfatal vascular events. Due consideration is needed in applying statin therapy in lower-risk primary prevention populations.”
Ray KK. Arch Intern Med. 2010;170:1024-1031.
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