SECOND AUSTRALIAN NATIONAL BLOOD PRESSURE STUDY ANBP2

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SECOND AUSTRALIAN NATIONAL BLOOD PRESSURE STUDY
(ANBP-2)

• Enalapril/ACEI vs. HCTZ, n 6,083
• Randomized, open-label (blinded endpoint review)
• All CV events or death from any cause
• HR 0.89 (0.79-1.00), p0.05
• First events
• CVD HR 0.88 (0.77-1.01), p 0.07
• CHD HR 0.86 (0.70-1.06), p 0.16
• Stroke HR 1.02 (0.78-1.33), p 0.91
• HF HR 0.85 (0.62-1.18), p 0.33

NEJM 2003348583-92
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SECOND AUSTRALIAN NATIONAL BLOOD PRESSURE STUDY
(ANBP-2)Results by Gender
NEJM 2003348583-92
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ALLHAT vs. ANBP2Baseline Characteristics
ALLHAT no washout, ANBP2 after washout
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ALLHAT vs. ANBP2Blood Pressure Endpoints
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ALLHAT vs. ANBP-2

• Randomized double-blind vs. PROBE design
• ACEI vs. thiazide-type diuretic, n 24,309 vs.
  6,083
• Number of patients with events
• CVD n 6,455 vs. 823
• CHD n 3,956 vs. 368
• Stroke n 1,132 vs. 219
• Heart failure n 1,482 vs. 147
• Treatment differences consistent across gender
  subgroup vs. differences noted only in men
• SBP slightly lower with diuretic in both trials

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CONCLUSIONS ALLHAT vs. ANBP2

• ALLHAT had 4 times the number of participants,
  5-10 times more endpoints, and a double-blinded
  design
• Even so, the upper 95 CI of ANPB2 compatible
  with ALLHAT point estimates of relative risk
• Coronary events
• Stroke
• Heart failure
• ALLHAT - no ACE advantage for any outcomes in
  either men or women, and heart failure outcomes
  were worse compared to the diuretic.
• While the aggregate analyses will have to await
  those planned by the Blood Pressure Lowering
  Treatment Trialists Collaboration, the totality
  of trial evidence from ALLHAT and other
  individual trials favors the diuretic.