Do angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers prolong life expectancy in patients with hypertension?

From the Guidelines

Both ACE inhibitors and calcium channel blockers can prolong life expectancy in patients with hypertension by reducing cardiovascular events and mortality, as demonstrated by the most recent and highest quality study available 1. These medications effectively lower blood pressure and provide additional protective effects on the heart, kidneys, and blood vessels. Key points to consider when prescribing these medications include:

• Starting doses: ACE inhibitors like lisinopril typically start at 10mg daily, while calcium channel blockers like amlodipine start at 5mg daily.
• Titration: Doses may be titrated up as needed to achieve blood pressure targets.
• Mechanism of action: ACE inhibitors block the renin-angiotensin-aldosterone system, reducing blood vessel constriction and fluid retention, while calcium channel blockers prevent calcium from entering heart and blood vessel cells, causing relaxation and dilation.
• Side effects: ACE inhibitors may cause a dry cough and are contraindicated in pregnancy, while calcium channel blockers might cause ankle swelling or constipation.
• Monitoring: Regular monitoring of blood pressure, kidney function, and electrolytes is essential when using these medications. The choice between these medications depends on individual patient factors, including age, race, comorbidities, and potential side effects, as highlighted in studies such as 2 and 3. Overall, the use of ACE inhibitors and calcium channel blockers can significantly reduce the risk of cardiovascular events and mortality in patients with hypertension, as demonstrated by the evidence 4, 1.

From the FDA Drug Label

In a multicenter, placebo-controlled clinical trial, 2,569 patients with all degrees of symptomatic heart failure and ejection fraction ≤35 percent were randomized to placebo or enalapril and followed for up to 55 months (SOLVD-Treatment) Use of enalapril was associated with an 11 percent reduction in all-cause mortality and a 30 percent reduction in hospitalization for heart failure.

In another multicenter, placebo-controlled trial (CONSENSUS) limited to patients with NYHA Class IV congestive heart failure and radiographic evidence of cardiomegaly, use of enalapril was associated with improved survival.

The ACE inhibitor enalapril has been shown to prolong life expectancy in patients with heart failure, with an 11% reduction in all-cause mortality in one study and improved survival in another.

• Key findings: + 11% reduction in all-cause mortality + 30% reduction in hospitalization for heart failure + Improved survival in patients with NYHA Class IV congestive heart failure However, the calcium channel blocker amlodipine has not been shown to have a significant effect on mortality in patients with coronary artery disease or heart failure [5] [6].

From the Research

Blood Pressure Medication and Life Expectancy

• The relationship between blood pressure medication and life expectancy is supported by various studies, which indicate that certain medications can help reduce the risk of cardiovascular disease (CVD) events and death 7, 8, 9, 10, 11.
• Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers are two classes of medications that have been shown to be effective in reducing blood pressure and improving cardiovascular outcomes 7, 8, 9, 11.
• A study published in the Journal of the American Medical Association (JAMA) found that first-line therapy for hypertension, including lifestyle modification and medication, can help reduce the risk of CVD events and death 7.
• Another study published in Minerva Medica found that the combination of an ACE inhibitor and a calcium channel blocker is a first-choice therapy for hypertension, as it has been shown to be effective in preventing myocardial infarction and total mortality 8.
• The American Family Physician journal also supports the use of combination therapy, including ACE inhibitors and calcium channel blockers, for the treatment of hypertension, especially in patients with high cardiovascular risk 9.
• A multicentre comparison study published in Current Medical Research and Opinion found that once-daily nifedipine and amlodipine are comparably safe and effective treatment options for patients with mild-to-moderate essential hypertension 10.
• A study published in Vnitrni Lekarstvi found that the combination of an ACE inhibitor and a calcium channel blocker is an optimal combination for the treatment of hypertension, as it provides an additional antihypertensive effect and minimizes the probability of adverse effects related to the dose of antihypertensive 11.

Key Findings

• ACE inhibitors and calcium channel blockers can help reduce the risk of CVD events and death 7, 8, 9, 11.
• Combination therapy, including ACE inhibitors and calcium channel blockers, is effective in treating hypertension, especially in patients with high cardiovascular risk 8, 9, 11.
• The fixed combination of an ACE inhibitor and a calcium channel blocker can increase compliance with treatment and improve cardiovascular outcomes 11.