Captopril Prevention Project

• this study set out to determine whether or not ACE inhibitors produced any extra benefits compared with traditional treatments
• large randomised open trial comparing the efficacy of beta-blockers/diuretics with captopril
• almost 11,000 patients were recruited (in Sweden and Finland). Patients were aged between 25-66 years and had a diastolic blood pressure reading of greater than or equal to 100 mmHg on one or two occasions
• patients with treated or untreated hypertension received captopril (up to 100 mg per day) or diuretic and/or beta-blocker. The treatment aim was to reduce diastolic blood pressure to 90 mmHg or less. If required, a calcium antagonist was added to the treatment regimen in each group. The mean follow-up was 6.1 years
• the study concluded that there were no significant differences in cardiovascular mortality and morbidity between captopril and conventional treatments. However the study data suggested that captopril was less protective against stroke than was treatment with beta blockers or diuretics or both. The STOP study however did not find differences in stroke mortality amongst comparing ACE inhibitors to other antihypertensive treatments (2)
• ACE inhibitors appear to be equally as effective as older therapies in the treatment of hypertension in primary care

Reference:

• (1) Hansson L et al, for the Captopril Prevention Project (CAPP) study group. Effect of angiotensin-converting- enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPP) randomised trial. Lancet (1999), 353, 611-16.
• (2) Hansson L, Lindholm LH, Ekbom T et al (1999). Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 Study. Lancet, 354, 1751-6.