The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials.
OBJECTIVE
Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce cardiovascular risk in different groups of patients. Whether these effects can be generalized to the broad group of patients with vascular disease is unknown. Therefore, we undertook a combined analysis using individual data from ADVANCE, EUROPA, and PROGRESS to determine the consistency of the treatment effect of perindopril-based regimen in patients with vascular disease or at high risk of vascular disease.


RESULTS
We studied all-cause mortality and major cardiovascular outcomes during a follow-up of about 4 years in the 29 463 patients randomly assigned a perindopril-based treatment regimen or placebo. The perindopril-based regimens were associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82-0.96; P = 0.006], cardiovascular mortality (HR 0.85; 95% CI 0.76-0.95; P = 0.004), non-fatal myocardial infarction (HR 0.80; 95% CI 0.71-0.90; P < 0.001), stroke (HR 0.82; 95% CI 0.74-0.92; P = 0.002), and heart failure (HR 0.84; 95% CI 0.72-0.96; P = 0.015). Results were consistent in subgroups with different clinical characteristics, concomitant medication use, and across all strata of baseline blood pressure.


CONCLUSIONS
This study provides strong evidence for a consistent cardiovascular protection with an ACE-inhibitor treatment regimen (perindopril-indapamide) by improving survival and reducing the risk of major cardiovascular events across a broad spectrum of patients with vascular disease.
Brugts
Jasper J
JJ
Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands. j.brugts@erasmusmc.nl
Ninomiya
Toshiharu
T
Boersma
Eric
E
Remme
Willem J
WJ
Bertrand
Michel
M
Ferrari
Roberto
R
Fox
Kim
K
MacMahon
Stephen
S
Chalmers
John
J
Simoons
Maarten L
ML
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002423:Cause of Death; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007190:Indapamide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000188:drug therapy* / Q000401:mortality
D000806:Angiotensin-Converting Enzyme Inhibitors; D007190:Indapamide; D020913:Perindopril