Antihypertensive Drug Class in Combination with Lipid Lowering Treatment for Primary Prevention of Cardiovascular Disease in the Elderly

Background: Antihypertensives and lipid-lowering therapy (LLT) are often used concurrently. Objectives: To determine whether there was a difference in clinical outcomes when older patients with LLT were prescribed angiotensin-converting-enzyme-inhibitors (ACE-Is) compared with diuretics. Methods: This analysis included 648 LLT older users free of cardiovascular disease (CVD) from a trial comparing ACE-I versus diuretic-based therapy. Comparisons were made between LLT+ACE-I (n = 335) and LLT +diuretic groups (n = 313) using multivariable Cox proportional-hazard models. Primary endpoints were allcause and CVD mortality (in-trial [4.1-year]+post-trial [6.9-year]) and secondary endpoints (in-trial) were the composite of all-cause mortality and first CVD events and its components, CVD mortality and incident diabetes. Results: There were no significant differences between the two groups for the primary endpoints over the intrial plus post-trial follow-up, nor was there a difference for any secondary outcomes over the in-trial follow-up. Conclusions: The LLT+ACE-I and LLT+diuretic combinations showed similar effects in CVD-free older individuals. Randomised trials are needed to provide conclusive evidence. (C) 2021 Elsevier Inc. All rights reserved.