Evidence map›Paper›PMID 12584366›Full record

Trial reportThe New England journal of medicine2003

A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly.

Lindon M H Wing, Christopher M Reid, Philip Ryan, Lawrence J Beilin, Mark A Brown, Garry L R Jennings, Colin I Johnston, John J McNeil, Graham J Macdonald, John E Marley and 3 more

Open access · greenAbstract readClinical TrialComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 263 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
263citing papers in PubMed, 16 pooled it
90.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

263 citing papers in PubMed, 16 syntheses or guidelines pooled it, 1,127 citations in OpenAlex.

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  2. Pharmacotherapy for mild hypertension.The Cochrane database of systematic reviews · 2025
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203 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 10 institutions in 1 country.

Lindon M H WingSchool of Medicine, Flinders University, Adelaide, Australia.
Christopher M Reid
Philip Ryan
Lawrence J Beilin
Mark A Brown
Garry L R Jennings
Colin I Johnston
John J McNeil
Graham J Macdonald
John E Marley
Trefor O Morgan
Malcolm J West
Second Australian National Blood Pressure Study Group
The Heart Research Institute · AUFlinders University · AUMonash University · AUMSD (Australia) · AUUniversity of Adelaide · AUUniversity of Melbourne · AUUniversity of Newcastle Australia · AUUniversity of Queensland · AUUniversity of Western Australia · AUUNSW Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTreatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the renin-angiotensin system confer benefit beyond the reduction of blood pressure alone. We compared the outcomes in older subjects with hypertension who were treated with angiotensin-converting-enzyme (ACE) inhibitors with the outcomes in those treated with diuretic agents.

methodsWe conducted a prospective, randomized, open-label study with blinded assessment of end points in 6083 subjects with hypertension who were 65 to 84 years of age and received health care at 1594 family practices. Subjects were followed for a median of 4.1 years, and the total numbers of cardiovascular events in the two treatment groups were compared with the use of multivariate proportional-hazards models.

resultsAt base line, the treatment groups were well matched in terms of age, sex, and blood pressure. By the end of the study, blood pressure had decreased to a similar extent in both groups (a decrease of 26/12 mm Hg). There were 695 cardiovascular events or deaths from any cause in the ACE-inhibitor group (56.1 per 1000 patient-years) and 736 cardiovascular events or deaths from any cause in the diuretic group (59.8 per 1000 patient-years; the hazard ratio for a cardiovascular event or death with ACE-inhibitor treatment was 0.89 [95 percent confidence interval, 0.79 to 1.00]; P=0.05). Among male subjects, the hazard ratio was 0.83 (95 percent confidence interval, 0.71 to 0.97; P=0.02); among female subjects, the hazard ratio was 1.00 (95 percent confidence interval, 0.83 to 1.21; P=0.98); the P value for the interaction between sex and treatment-group assignment was 0.15. The rates of nonfatal cardiovascular events and myocardial infarctions decreased with ACE-inhibitor treatment, whereas a similar number of strokes occurred in each group (although there were more fatal strokes in the ACE-inhibitor group).

conclusionsInitiation of antihypertensive treatment involving ACE inhibitors in older subjects, particularly men, appears to lead to better outcomes than treatment with diuretic agents, despite similar reductions of blood pressure.

Indexed as

AgedAged, 80 and overAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBlood PressureCardiovascular DiseasesDiureticsDrug Therapy, CombinationFemaleHumansHypertensionMaleProspective StudiesSex FactorsAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsDiuretics

Identifiers

PMID12584366
OpenAlexW2146851676

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.