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In a study presented in JAMA Network Open, researchers sought to determine the difference in the long-term risk of mortality and morbidity outcomes for adults with hypertension taking a thiazide-type diuretic, calcium channel blocker (CCB), or angiotensin-converting enzyme (ACE) inhibitor. Their secondary analysis found that mortality due to cardiovascular disease was similar among patients, regardless of which treatment was used. However, compared with the diuretic group, the ACE inhibitor group had a 19% increased risk of stroke mortality and an 11% increased risk of hospitalization from stroke (combined fatal and nonfatal). In total, researchers analyzed outcomes of 32,804 patients in a randomized clinical trial, following them over time, up to 23 years later. Cardiovascular disease mortality rates per 100 persons were 21.6 in the CCB group, 23.7 in the diuretic group, and 23.8 in the ACE inhibitor group.

That’s a lot of people: According to the Centers for Disease Control and Prevention, nearly half of all American adults have hypertension—119.9 million people, with only about 27 million having their condition under control. 

ACE Inhibitors Show Less Protection Against Stroke Mortality