By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

The standard recommendation for the treatment of hypertension is to start with beta blockers and diuretics. This is because these are the only drugs that have been proven to lower the risks of having a stroke or a heart attack. The CAPPP study (Captopril Prevention Project) was undertaken in Scandinavia to see if treatment with captopril, the first drug of the class called ACE (Angiotensin Converting Enzyme) inhibitors, would give better protection. It was conducted on 10,985 patients, half of whom were given captopril, and half diuretics or beta blockers. After five years of treatment, the number of deaths and heart attacks were the same in both groups. However, strokes were a little more common in the group given captopril. Patients being treated with captopril were less likely to develop diabetes.

Doctor's comments

This is the first of many studies to test the possibility that treatment of high blood pressure with some of the newer types of drugs such as ACE inhibitors will give better protection against strokes and heart attacks than the traditional beta blockers and diuretics. The results show no special advantage of captopril except for preventing diabetes, itself a major risk factor for cardiovascular disease. Other studies have shown that ACE inhibitors do have some advantages over other blood pressure medications in people who have diabetes. A limitation of the study was that captopril was only given once or twice a day, and may not have controlled blood pressure for the full 24-hour period. It would have been better if the captopril had been given two or three times a day.

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