A Comparison of Outcomes with Angiotensin-Converting-Enzyme Inhibitors and Diuretics for Hypertension in the Elderly
 

This research looked at 6083 adults 65-84 years of age with hypertension and compared the benefits of ace inhibitors compared to diuretics. Those on ace inhibitors had fewer "cardiovascular events or death" compared to those on diuretics, in spite of a similar reduction in blood pressure. Comment: the abstract of this article makes it very unclear whether or not ACE inhibitors are better than diuretics because of the decision by the authors to clump together cardiovascular events and death. For example, if there were 35 deaths and 15 cardiovascular events per 1000 people in the ACE inhibitor group, the "event rate" would be 50/1000. If there were 15 deaths and 40 cardiovascular events in the diuretic group, the event rate would be 55/1000, making the event rate for diuretics worse than the event rate for ACE inhibitors. Yet most people would still prefer the diuretics because their chance of death would be more than twice as great if they were taking an ACE inhibitor. Furthermore, exactly what constituted a "cardiovascular event" was not clear. Unlike the journal BMJ, the New England Journal of Medicine has decided to restrict access to its publication (requiring a cash payment to view full text articles). Thus, healthcare professionals (especially in poor, developing countries) cannot fully benefit from NEJM. That is why BMJ, which has chosen to make its contents freely available online, remains the premier online medical research journal. [ NEJM Volume 348:583-592 February 13, 2003 Number 7 ]