FACET trials boosts status of ACE inhibitors
The ACE inhibitor fosinopril is being credited with a 51% reduction in heart attacks, stroke, and angina requiring hospitalization when compared to the calcium channel blocker amlodipine. That's the bottom line of a 3½-year study of 380 hypertensive diabetic patients, called FACET (Fosinopril Amlodipine Cardiovascular Events Trial), undertaken at the University of Tennessee-Memphis, Wake Forest University in Winston-Salem, NC, and two hospital groups in Italy.
The FACET study was the first randomized trial specifically done to compare an ACE inhibitor with a long-acting calcium channel blocker, its researchers say. "The results are exciting because they challenge current clinical practice by suggesting that ACE inhibitors and low-dose diuretics should be the treatment of choice for preventing cardiovascular events," says Marco Pahor, MD, associate professor of medicine in the University of Tennessee-Memphis' department of preventative medicine. "Previously, physicians assumed that if a drug can reduce blood pressure, it should offer equal protection against the risk of heart attacks or strokes, but the study suggests that blood pressure reduction alone may not be a sufficient marker of drug efficacy."
He points out that while the study's results are promising in terms of ACE inhibitor use, two related follow-up studies will attempt to legitimize the FACET study and to further the comparison of the two drugs. The first, FACTS (Fosinopril vs. Amlodipine Comparative Treatments Study) is planned as a randomized, double-blind trial of 104 hypertensive diabetics comparing the drugs' affects on fibrinolysis, endothelial dysfunction and inflammation, which Pahor says have been identified as significant risk factors for these patients. From there, researchers plan to embark on the FOAM (Fosinopril and Amlodipine) study, which plans to follow 307 hypertensive patients with left ventricular hypertrophy with or without albuminuria, also in a randomized, double-blind setting.
[For more on the studies, contact Marco Pahor, MD, at (917) 833-7884.]
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