Кардиоваскулярная терапия и профилактика (Aug 2009)
Comparing recommended doses of angiotensin receptor blockers and ACE inhibitors (CORD Study)
Abstract
Aim. The CORD Study compared effectiveness and tolerability of losartan and ramipril in patients with arterial hypertension (AH).Material and methods. The study included two groups, A and B. In Group A (n=4016; mean age 62,6+11,6 years; 53,1% women), the patients with blood pressure (BP) <160/100 mm Hg and ACE inhibitor therapy lasting for >3 months were switched from ACE inhibitors to losartan. At baseline and 1, 3, 6, and 12 months later, BP, heart rate, and biochemical parameters were measured; general blood assay and electrocardiography (ECG) were also performed. In group B (n=3813; mean age 60,5+12,2 years; 50,5% women), the patients with BP >140/90 mm Hg and no previous ACE inhibitor or angiotensin receptor blocker (ARB) therapy were randomly administered either losartan (50 mg/d; n=1887) or ramipril (5 mg/d; n=1926).Results. Group A demonstrated a decrease in BP — from 147,4+14,8/87,7+9,3 to 139,7+11,8/83,0+9,3 mm Hg (p<0,001) after one month of the treatment, and to 133,7+11,3/79,1+7,06 mm Hg (p<0,001) after one year. Adverse effect prevalence did not increase. After one year, Group B demonstrated a reduction in BP levels — in losartan subgroup, from 156,5+13,1/93,4+8,8 to 134,55+11,3/80,16+6,6 mm Hg (p<0,001), and in ramipril subgroup — from 155,9+13,1/93,0+8,9 to 134,1+11,2/81,5+6,8 mm Hg (p<0,001). No severe adverse effects were registered, but in ramipril subgroup, cough was 8 times more prevalent.Conclusion. ACE inhibitor substitution with losartan was safe and effective. Losartan and ramipril demonstrated equal antihypertensive effectiveness and a tendency to improve metabolic parameters. Losartan therapy was better tolerated than ramipril.
