gms | German Medical Science

27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga

Deutsche Liga zur Bekämpfung des hohen Blutdrucks – Deutsche Hypertonie Gesellschaft e. V.

26. bis 29.11.2003, Bonn

Metabolic effects of 5 years antihypertensive treatment in elderly patients with concomitant diseases: ACE-Inhibitors/Ca-Antagonists vs. Beta-Blockers/Diuretics: Data from the DELMUNO-Project

Metabolische Veränderungen bei älteren Hypertonikern mit Begleiterkrankungen unter 5-jähriger Hochdrucktherapie mit ACE-Hemmern/Ca-Antagonisten vs. Beta-Blocker/Diuretika unter Praxisbedingungen (DELMUNO-Projekt)

Meeting Abstract (Hypertonie 2003)

  • presenting/speaker S. Lüders - St. Josefs-Hospital (Cloppenburg, D)
  • A. Kulschewski - St. Josefs-Hospital (Cloppenburg, D)
  • F. Hammersen - St. Josefs-Hospital (Cloppenburg, D)
  • C. Züchner - St. Josefs-Hospital (Cloppenburg, D)
  • J. Schrader - St. Josefs-Hospital (Cloppenburg, D)

Hypertonie 2003. 27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Bonn, 26.-29.11.2003. Düsseldorf, Köln: German Medical Science; 2004. Doc03hochP27

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/hoch2003/03hoch127.shtml

Veröffentlicht: 11. November 2004

© 2004 Lüders et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Background

Antihypertensive treatment for elderly patients with concomitant diseases is still a matter of discussion. According to ALLHAT-invetigators diuretics should be considered for first-line, but metabolic side effects of diuretics are quite common.

Question

Is there an advantage for ACE-Inhibitors/Ca-Antagonists compared to beta-blockers/diuretics when elderly hypertensive patients are treated according to guidelines of German hypertension league considering concomitant internal diseases with regard to metabolic parameters.

Study design

Open, prospective 5-years multicenter-observation. Group (grp) 1: ACE-inhibitor (Ramipril) and/or Calcium-channel-blocker (Felodipine); grp 2: Beta1-blocker and/or diuretics. Hypertensive patients (60-80 years; >140 and/or >90 mmHg, office blood pressure (bp)).

Results

Data could be analysed for 1311 patients in 134 medical centers which participated for 5 years. The patients were treated by decision of their physician and were asigned to the groups according to initial medication: Grp1, n=655; grp 2, n=656. All patients had at least one concomitant internal disease at study-entry (diabetes mellitus, COLD, CHD, cerebrovascular events, heart failiure, hyperuricemia, renal insufficiency, hyperlipidemia). Significant more patients with diabetes and after cerebrovascular events have initally been treated with ACE-Inhibitors/Ca-antagonists. There were significant metabolic changes from baseline to end in advantage for grp1. Grp 1 vs. 2: glucose -10.5/-1.2%; cholesterol -9.5/-6.5%; triglyceride (diabetics) -11.6/+1.4%.

Bp level was comparable during follow up and at the end. Although there were more high risk patients in grp 1 cardiovascular morbidity/total mortality was lower in grp 1 (15,6 vs. 17,4%).

Conclusion

ACE-inhibitors/calcium-channel-blockers have metabolic advantages in elderly patients with concomitant internal diseases in long-term treatment.