title: Cardiovascular and cerebrovascular outcomes in elderly hypertensive patients treated with either ARB or ACEI.
abstract: BACKGROUND
  Although angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are equally important in the treatment of hypertension, there is less evidence whether they have equal cardiovascular and cerebrovascular protective effects, especially in elder hypertensive patients. This study aims to clarify this unresolved issue.
  
  
  METHODS
  This cross-sectional study included clinical data on 933 aged male patients with hypertension who received either an ARB or ACEI for more than two months between January 2007 and May 2011. The primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary endpoints were unstable angina, new atrial fibrillation, and transient ischemic attack.
  
  
  RESULTS
  The median follow-up time was 24 months. Age, drug types, cerebral infarction history, renal dysfunction history were the independent predictors of the primary endpoint. The risk of an occurrence of a primary endpoint event was higher in the ARB group than the ACEI group [P = 0.037, hazard ratios (HR): 2.124, 95% confidence interval (95% CI): 1.048-4.306]. The Kaplan-Meier method also suggests that the rate of primary endpoint occurrence was higher in the ARB group than the ACEI group (P = 0.04). In regard to the secondary endpoints, there were no significant differences between the two treatment arms (P = 0.137, HR: 1.454, 95% CI: 0.888-2.380). Patient age and coronary heart disease history were independent predictors of the secondary endpoint.
  
  
  CONCLUSIONS
  ACEI were more effective than ARB in reducing cardiovascular and cerebrovascular morbidity and mortality in aged patients with hypertension.
authors.affiliation: The First Department of Geriatric Cardiology, South Building, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Ma
authors.forename: Jian
authors.initials: J
authors.lastname: Cao
authors.forename: Xue-Chun
authors.initials: XC
authors.lastname: Lu
authors.forename: Xin-Hong
authors.initials: XH
authors.lastname: Guo
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
authors.forename: Xian-Feng
authors.initials: XF
authors.lastname: Liu
authors.forename: Li
authors.initials: L
authors.lastname: Fan
keywords: Angiotensin converting enzyme inhibitor; Angiotensin receptor blocker; Angiotensin type 2 receptor; Renin-angiotensin-aldosterone system