CORD study – an analysis of patients aged 80 years and patients with isolated systolic hypertension
Authors:
J. Špinar; J. Vítovec; M. Souček; L. Dušek; T. Pavlík Za Řešitele Studie Cord
Authors‘ workplace:
Interní kardiologická klinika FN Brno a LF MU, Brno, I. interní kardio-angiologická klinika FN USA a LF MU, Brno, II. interní klinika FN USA a LF MU, Brno, Institut Biostatistiky a analýz LF MU, Brno
Published in:
Kardiol Rev Int Med 2010, 12(1): 21-27
Overview
The CORD study – COmparison of Recommended Doses – was one of the largest Czech Republic‑based clinical studies in hypertension. The study involved 585 centres and 11,284 screened patients, out of which 11,284 were randomised into the CORD A or CORD B study. The effect observed in patients above the age of 80 was the same as in patients under 80 years of age; we did not identify any difference in the reduction of blood pressure or in the incidence of adverse events, including renal functions. Patients with isolated systolic hypertension differed from the others particularly with respect to the effects on diastolic blood pressure that was only marginally reduced while the reduction of systolic pressure was comparable to patients with systolic- diastolic hypertension. This observation was highly statistically significant. In patients with isolated systolic hypertension, losartan was more effective than ramipril in reducing systolic blood pressure (p = 0.02), while both agents produced equal reduction of diastolic blood pressure.
Key words:
losartan – ramipril – systolic hypertension – older age
Sources
1. Špinar J, Vítovec J, Souček M et al for the CORD investigators: CORD: COmparison Of Recommended Doses of ACE inhibitors and angiotensin II receptor blockers. Vnitř Lék 2009; 55: 481– 488.
2. Špinar J, Vítovec J, Souček M et al for the CORD investigators: CORD: COmparison Of Recommended Doses of ACE inhibitors and angiotensin II receptor blockers. Kardiovaskularnaja merania i profilaksia 2009; 8: 63– 70.
3. Špinar J, Vítovec J, Souček M et al. CORD – comparison of recommended doses of ace inhibitors and angiotensin II receptor blockers. Int J Cardiol 2009; Available online 17 March 2009. [http:/ / www. sciencedirect.com].
4. Blood Pressure Lowering Treatment Trialists’ Collaboration. Blood pressure‑dependent and independent effects of agents that inhibit the renin‑angiotensin system. J Hypertens 2007; 25: 951– 958.
5. Dickstein K, Kjekshus J. OPTIMAAL Steering Committee of the OPTIMAAL Study Group. Effects of losartan and captopril on mortality and morbidity in high‑risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan. Lancet 2002; 360: 752– 760.
6. Flather MD, Yusuf S, Køber L et al. Long term ACE‑inhibitor therapy in patients with heart failure or left- ventricular dysfunction: a systematic overview of data from individual patients. ACE- Inhibitor Myocardial Infarction Collaborative Group. Lancet 2000; 355: 1575– 1581.
7. Fox KM. The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double‑blind, placebo- controlled, multicenter trial (the EUROPA study). Lancet 2003; 362: 782– 788.
8. Julius S, Kjeldsen SE, Weber M et al. 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.
9. Pfeffer MA, McMurray JJ, Velazquez EJ et al. Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003; 349: 1893– 1906.
10. Pitt B, Poole- Wilson PA, Segal R et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomized trial: the Losartan Heart Failure Survival Study ELITE II. Lancet 2000; 355: 1582– 1587.
11. Spinar J, Vitovec J, Pluhacek L et al. First dose hypotension after angiotensin converting enzyme inhibitor captopril and angiotensin II blocker losartan in patients with acute myocardial infarction. Int J Cardiol 2000; 75: 197– 204.
12. Spinar J, Vitovec J, Spinarova L et a. A comparison of intervention with losartan or captopril in acute myocardial infarction. Eur J Heart Failure 2000; 2: 91– 100.
13. The ONTARGET investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547– 1559.
14. Cohn JN, Tognoni G. Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin‑receptor blocker valsartan in chronic heart failure. N Engl J Med 2001; 345: 1667– 1675.
15. Yusuf S, Sleight P, Pogue J et al. 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.
16. Sever PS, Dahlöf B, Poulter NR et al. ASCOT investigators. Prevention of coronary stroke events with atorvastatin in hypertensive patients who have average or lower- than- average cholesterol concentrations, in the Anglo- Scandinavian Cardiac Outcomes Trial- Lipid Lowering Arm (ASCOT- LLA): a multicentre randomised controlled trial. Lancet 2003; 361: 1149– 1158.
17. Dahlöf B, Devereux RB, Kjeldsen SE, for the LIFE investigators. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoints reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995– 1003.
18. Nissen SE, Tuzcu EM, Libby P. CAMELOT Investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004; 292: 2217– 2226.
19. Poulter NR, Wedel H, Dahlöf B et al. ASCOT Investigators. Role of blood pressure and other variables in the differential cardiovascular event rate noted in the Anglo- Scandinavian Cardiac Outcomes Trial- Blood Pressure Lowering Arm (ASCOT- BPLA). Lancet 2005; 366: 907– 913.
20. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high‑risk hypertensive patients randomised to angiotensin‑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.
21. Mancia G, Grassi G. Systolic and diastolic blood pressure control in hypertensive drug trials. J Hypertens 2002; 20: 1461– 1464.
22. Mancia G, Laurent S, Agabiti- Rosei L et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force dokument. J Hypertens 2009; 27: 2121– 2158.
23. Mancia G, De Backer G, Dominiczak A. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105– 1187.
24. Becket NS, Peters R, Flether AE. HYVET Study group. Treatment of hypertension in patients 80 years of age and older. N Engl J Med 2008; 358: 1887– 1898.
25. Forette F, Seux ML, Staessen JA et al. Systolic Hypertension in Europe Investigators. The prevention of demntia with antihypertensive treatment. New evidence from Systolic Hypertension in Europe (SYST EUR) study. Arch Intern Med 2002; 162: 2046– 2052.
26. Waeber B, Mourad JJ. Targeting systolic blood pressure: the key to controlling combined systolic/ diastolic hypertension. Am J Hypertens 2006; 19: 985– 986.
27. Widimský J. Izolovaná systolická hypertenze starších osob. Cor Vasa 2009; 51: 698– 707.
28. Benetos A, Zureik M, Morcet J et al. A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men. J Am Coll Cardiol 2000; 35: 673– 880.
29. Blacher J, Staessen JA, Girerd X et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000; 160: 1085– 1089.
30. Staessen JA, Gasowski J, Wang JG et al. Risk of untreated and treated isolated systolic hypertension in the elderly: meta‑analysis of outcome trials. Lancet 2000; 355: 865– 872.
31. SHEP study group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991; 265: 3255– 3264.
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