Abstract
The purpose of this study was to compare the effect of different classes of antihypertensives on the risk of cardiovascular events in a case-control study of hypertensive patients. The subjects consisted of 171 hypertensive patients who had experienced a cardiovascular event and 537 randomly selected hypertensive controls who were matched to the cases by gender, age, and hospital/clinic. Both cases and controls had been under antihypertensive medication for at least 6 months before the onset of the cardiovascular event (cases) or before the enrollment (controls). A total of 134 physicians across the nation recruited cases and controls, and reported details of the prescription of antihypertensives and clinical and behavioral variables of their patients. Although there was no measurable difference in the risk of cardiovascular events according to the class of antihypertensives, statistically significant increases in the risk of cardiovascular events were observed for non-use of calcium antagonists among patients with angina pectoris and for non-use of the renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitor and angiotensin II receptor blockers combined) among patients with diabetes mellitus. Higher levels of blood pressure were associated with an increased risk of cardiovascular events. The findings suggest that appropriate control of blood pressure is more important in the treatment of hypertension than the choice of antihypertensives.
Similar content being viewed by others
Article PDF
References
World Health Organization, International Society of Hypertension Writing Group : 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21: 1983–1992.
Chobanian AV, Bakris GL, Black HR, the National High Blood Pressure Education Program Coordinating Committee : The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 report. JAMA 2003; 289: 2560–2572.
Japanese Society of Hypertension Guidelines Subcommittee for the Management of Hypertension : Guidelines for the management of hypertension for general practitioners. Hypertens Res 2001; 24: 613–634.
Pahor M, Pasty BM, Alderman MH, et al: Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomised controlled trials. Lancet 2000; 356: 1949–1954.
Blood Pressure Lowering Treatment Trialists' Collaboration : Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362: 1527–1535.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group : Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2000; 283: 1967–1975.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group : Major outcomes in high-risk hypertensive patients randomized to angiotension-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–2997.
Dahlöf B, Devere RB, Kjeldsen SE, et al, for the Life Study group : Cardiovascular mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
Julius S, Kjeldsen SE, Weber M, et al, for VALUE trial group : Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004; 363: 2022–2031.
The GLANT Study Group : A 12-month comparison of ACE inhibitor and Ca antagonist therapy in mild to moderate essential hypertension—the GLANT Study. Hypertens Res 1995; 18: 235–244.
Yui Y, Sumiyoshi T, Kodama K, et al: Comparison of nifedipine retard with angiotensin converting enzyme inhibitors in Japanese hypertensive patients with coronary artery disease: the Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) randomized trial. Hypertens Res 2004; 27: 181–191.
The Lipid Research Clinics Program. The coronary primary prevention trail : design and implementation. J Chronic Dis 1979; 32: 609–631.
Inukai O, Shimamoto K, Matsuda K, et al: Effects of angiotensin converting enzyme inhibitor on insulin sensitivity in fructose-fed hypertensive rats and essential hypertensives. Am J Hypertens 1995; 8: 353–357.
Okada K, Hirano T, Ran J, Adachi M : Olmesartan medoxomil, an angiotensin II receptor blocker ameliorates insulin resistance and decreases triglyceride production in fructose-fed rats. Hypertens Res 2004; 27: 293–299.
The Heart Outcomes Prevention Evaluation Study Investigators : Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145–153.
Heart Outcomes Prevention Evaluation (HOPE) Study Iinvestigators : Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253–259.
Estacio RO, Jeffers BW, Hiatt WR, Biggerstaff SL, Gifford N, Schrier RW : The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-depended diabetes and hypertension. N Eng J Med 1998; 338: 645–652.
Tatti P, Guarisco R, Pahor M, et al: Outcome results of the fosinopril versus amlodipine cardiovascular events randomized trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998; 21: 597–603.
Yui Y, Sumiyoshi T, Kodama K, et al: Nifedipine retard was as effective as angiotensin converting enzyme inhibitors in preventing cardiac events in high-risk hypertensive patients with diabetes and coronary artery disease: the Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) subgroup analysis. Hypertens Res 2004; 27: 449–456.
Ishizaka N, Ishizaka Y, Toda E, Hashimoto H, Nagai R, Yamakado M : Hypertension is the most common component of metabolic syndrome and the greatest contributor to carotid arteriosclerosis in apparently healthy Japanese individuals. Hypertens Res 2005; 28: 27–34.
Hirose H, Saito I : Trends in blood pressure control in hypertensive patients with diabetes mellitus in Japan. Hypertens Res 2003; 26: 717–722.
Lightlen PR, Hugenholtz PG, Rafflenbeul W, on behalf of the INTACT group investigators : Retardation of angiographic progression of coronary artery disease by nifedipine. Results of the International Nifedipine Trial on Antiatherosclerotic Therapy (INTACT). Lancet 1990; 335: 1109–1113.
Waters D, Lespérance J, Francetich M, et al: A controlled clinical trial to assess the effect of a calcium channel blocker on the progression of coronary atherosclerosis. Circulation 1990; 82: 1940–1953.
Pitt B, Byington RP, Furberg CD, et al, for the PREVENT Investigators : Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000; 102: 1503–1510.
Saito I, Kawabe H, Tsujioka M, Hirose H, Shibata H : Trends in pharmacologic management of hypertension in Japan one year after the publication of the JSH 2000 guidelines. Hypertens Res 2002; 25: 175–178.
Yamamoto Y, Sonoyama K, Matsubara K, et al: The status of hypertension management in Japan in 2000. Hypertens Res 2002; 25: 717–725.
Concato J, Sham N, Horwitz RI : Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000; 342: 1887–1892.
Pocock SJ, Elbourne D : Randomized trials or observational tribulations? N Engl J Med 2000; 342: 1907–1909.
Du X, Cruickshank K, McNamee R, et al: Case-control study of stroke and the quality of hypertension control in north west England. BMJ 1997; 314: 272–276.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kono, S., Kushiro, T., Hirata, Y. et al. Class of Antihypertensive Drugs, Blood Pressure Status, and Risk of Cardiovascular Disease in Hypertensive Patients: A Case-Control Study in Japan. Hypertens Res 28, 811–817 (2005). https://doi.org/10.1291/hypres.28.811
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.28.811