Captopril Prevention Project - CAPPP


The goal of this study was to determine if antihypertensive therapy with captopril offered any benefits over conventional therapy with beta-blockers and diuretics.


Angiotensin-converting enzyme (ACE) inhibitors are known to have many beneficial effects that go beyond systemic arterial blood pressure control. It was hypothesized that antihypertensive therapy with captopril would be associated with a reduction in fatal and nonfatal myocardial infarctions (MIs), stroke, and other cardiovascular deaths when compared to conventional therapy with diuretics, beta-blockers, or a combination of the two.

Study Design

Study Design:

Patients Screened: 11,018
Patients Enrolled: 10,985
Mean Follow Up: mean 6.1 years
Mean Patient Age: 25-66
Female: 47

Patient Populations:

Patients 25-66 years of age with diastolic BP >100 mm Hg on two occasions


Secondary hypertension, serum creatinine >150 μmol/l, and disorders requiring treatment with a beta-blocker

Primary Endpoints:

Fatal and nonfatal MI, stroke, and other cardiovascular deaths

Drug/Procedures Used:

Eligible patients were randomized to receive either captopril at a starting dose of a total of 50 mg per day or a beta-blocker, diuretic, or a combination of beta-blocker and diuretic. The medications were titrated to a target supine diastolic blood pressure (BP) <90 mm Hg.

Concomitant Medications:

If the target BP could not be achieved with captopril or a combination of beta-blockers and diuretics, calcium channel blockers were allowed to be added.

Principal Findings:

There was not a significant difference between the two groups in the incidence of the composite endpoint of fatal and nonfatal MI, stroke, and other cardiovascular deaths (11.1 and 10.2 events per 1,000 patient-years in captopril and conventional therapy groups; p=0.52). The captopril group had a trend toward lower cardiovascular mortality (relative risk [RR] 0.77; p=0.092), but a higher incidence of fatal and nonfatal stroke (RR 1.15; p=0.044).

MI rates were similar between the two groups (162 events in the captopril group and 161 events in the conventional therapy group). Lower stroke risk in the conventional group probably was due to lower initial BP (−2 mm Hg).


Among patients with a diastolic BP >100 mm Hg, there was no significant difference between captopril therapy and conventional therapy in the incidence of cardiovascular morbidity and mortality. The increase in stroke risk in the captopril group was felt to be secondary to significantly higher initial BPs in that group.


Hansson L, Lindholm LH, Niskanen L, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999;353:611-6.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Statins, Hypertension

Keywords: Stroke, Myocardial Infarction, Arterial Pressure, Diuretics, Blood Pressure, Captopril, Drug Combinations, Eye Abnormalities, Hydrochlorothiazide, Hypertension

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