Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Advertisement

Hypertension Research
  • View all journals
  • Search
  • Log in
  • Content Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • RSS feed
  1. nature
  2. hypertension research
  3. original article
  4. article
Class of Antihypertensive Drugs, Blood Pressure Status, and Risk of Cardiovascular Disease in Hypertensive Patients: A Case-Control Study in Japan
Download PDF
Download PDF
  • Original Article
  • Published: 01 October 2005

Class of Antihypertensive Drugs, Blood Pressure Status, and Risk of Cardiovascular Disease in Hypertensive Patients: A Case-Control Study in Japan

  • Suminori Kono1,
  • Toshio Kushiro2,
  • Yasunobu Hirata3,
  • Chikuma Hamada4,
  • Atsuhiko Takahashi5 &
  • …
  • Yuji Yoshida6 

Hypertension Research volume 28, pages 811–817 (2005) Cite this article

  • 1877 Accesses

  • 3 Altmetric

  • Metrics details

Abstract

The purpose of this study was to compare the effect of different classes of antihypertensives on the risk of cardiovascular events in a case-control study of hypertensive patients. The subjects consisted of 171 hypertensive patients who had experienced a cardiovascular event and 537 randomly selected hypertensive controls who were matched to the cases by gender, age, and hospital/clinic. Both cases and controls had been under antihypertensive medication for at least 6 months before the onset of the cardiovascular event (cases) or before the enrollment (controls). A total of 134 physicians across the nation recruited cases and controls, and reported details of the prescription of antihypertensives and clinical and behavioral variables of their patients. Although there was no measurable difference in the risk of cardiovascular events according to the class of antihypertensives, statistically significant increases in the risk of cardiovascular events were observed for non-use of calcium antagonists among patients with angina pectoris and for non-use of the renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitor and angiotensin II receptor blockers combined) among patients with diabetes mellitus. Higher levels of blood pressure were associated with an increased risk of cardiovascular events. The findings suggest that appropriate control of blood pressure is more important in the treatment of hypertension than the choice of antihypertensives.

Similar content being viewed by others

A multi-centre study of prescribing patterns for the management of resistant hypertension amongst cardiologists

Article 17 March 2026

Hypertension: sex-related differences in drug treatment, prevalence and blood pressure control in primary care

Article Open access 19 January 2023

Cardiovascular risk in patients receiving antihypertensive drug treatment from the perspective of endothelial function

Article 20 May 2022

Article PDF

References

  1. World Health Organization, International Society of Hypertension Writing Group : 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21: 1983–1992.

  2. Chobanian AV, Bakris GL, Black HR, the National High Blood Pressure Education Program Coordinating Committee : The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  Google Scholar 

  3. Japanese Society of Hypertension Guidelines Subcommittee for the Management of Hypertension : Guidelines for the management of hypertension for general practitioners. Hypertens Res 2001; 24: 613–634.

    Article  Google Scholar 

  4. Pahor M, Pasty BM, Alderman MH, et al: Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomised controlled trials. Lancet 2000; 356: 1949–1954.

    Article  CAS  Google Scholar 

  5. Blood Pressure Lowering Treatment Trialists' Collaboration : Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362: 1527–1535.

  6. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group : Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2000; 283: 1967–1975.

  7. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group : Major outcomes in high-risk hypertensive patients randomized to angiotension-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–2997.

  8. Dahlöf B, Devere RB, Kjeldsen SE, et al, for the Life Study group : Cardiovascular mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.

    Article  Google Scholar 

  9. Julius S, Kjeldsen SE, Weber M, et al, for VALUE trial group : Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004; 363: 2022–2031.

    Article  CAS  Google Scholar 

  10. The GLANT Study Group : A 12-month comparison of ACE inhibitor and Ca antagonist therapy in mild to moderate essential hypertension—the GLANT Study. Hypertens Res 1995; 18: 235–244.

    Article  Google Scholar 

  11. Yui Y, Sumiyoshi T, Kodama K, et al: Comparison of nifedipine retard with angiotensin converting enzyme inhibitors in Japanese hypertensive patients with coronary artery disease: the Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) randomized trial. Hypertens Res 2004; 27: 181–191.

    Article  CAS  Google Scholar 

  12. The Lipid Research Clinics Program. The coronary primary prevention trail : design and implementation. J Chronic Dis 1979; 32: 609–631.

  13. Inukai O, Shimamoto K, Matsuda K, et al: Effects of angiotensin converting enzyme inhibitor on insulin sensitivity in fructose-fed hypertensive rats and essential hypertensives. Am J Hypertens 1995; 8: 353–357.

    Article  Google Scholar 

  14. Okada K, Hirano T, Ran J, Adachi M : Olmesartan medoxomil, an angiotensin II receptor blocker ameliorates insulin resistance and decreases triglyceride production in fructose-fed rats. Hypertens Res 2004; 27: 293–299.

    Article  CAS  Google Scholar 

  15. The Heart Outcomes Prevention Evaluation Study Investigators : Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145–153.

  16. Heart Outcomes Prevention Evaluation (HOPE) Study Iinvestigators : Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253–259.

  17. Estacio RO, Jeffers BW, Hiatt WR, Biggerstaff SL, Gifford N, Schrier RW : The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-depended diabetes and hypertension. N Eng J Med 1998; 338: 645–652.

    Article  CAS  Google Scholar 

  18. Tatti P, Guarisco R, Pahor M, et al: Outcome results of the fosinopril versus amlodipine cardiovascular events randomized trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998; 21: 597–603.

    Article  CAS  Google Scholar 

  19. Yui Y, Sumiyoshi T, Kodama K, et al: Nifedipine retard was as effective as angiotensin converting enzyme inhibitors in preventing cardiac events in high-risk hypertensive patients with diabetes and coronary artery disease: the Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) subgroup analysis. Hypertens Res 2004; 27: 449–456.

    Article  CAS  Google Scholar 

  20. Ishizaka N, Ishizaka Y, Toda E, Hashimoto H, Nagai R, Yamakado M : Hypertension is the most common component of metabolic syndrome and the greatest contributor to carotid arteriosclerosis in apparently healthy Japanese individuals. Hypertens Res 2005; 28: 27–34.

    Article  Google Scholar 

  21. Hirose H, Saito I : Trends in blood pressure control in hypertensive patients with diabetes mellitus in Japan. Hypertens Res 2003; 26: 717–722.

    Article  Google Scholar 

  22. Lightlen PR, Hugenholtz PG, Rafflenbeul W, on behalf of the INTACT group investigators : Retardation of angiographic progression of coronary artery disease by nifedipine. Results of the International Nifedipine Trial on Antiatherosclerotic Therapy (INTACT). Lancet 1990; 335: 1109–1113.

    Article  Google Scholar 

  23. Waters D, Lespérance J, Francetich M, et al: A controlled clinical trial to assess the effect of a calcium channel blocker on the progression of coronary atherosclerosis. Circulation 1990; 82: 1940–1953.

    Article  CAS  Google Scholar 

  24. Pitt B, Byington RP, Furberg CD, et al, for the PREVENT Investigators : Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000; 102: 1503–1510.

    Article  CAS  Google Scholar 

  25. Saito I, Kawabe H, Tsujioka M, Hirose H, Shibata H : Trends in pharmacologic management of hypertension in Japan one year after the publication of the JSH 2000 guidelines. Hypertens Res 2002; 25: 175–178.

    Article  Google Scholar 

  26. Yamamoto Y, Sonoyama K, Matsubara K, et al: The status of hypertension management in Japan in 2000. Hypertens Res 2002; 25: 717–725.

    Article  Google Scholar 

  27. Concato J, Sham N, Horwitz RI : Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000; 342: 1887–1892.

    Article  CAS  Google Scholar 

  28. Pocock SJ, Elbourne D : Randomized trials or observational tribulations? N Engl J Med 2000; 342: 1907–1909.

    Article  CAS  Google Scholar 

  29. Du X, Cruickshank K, McNamee R, et al: Case-control study of stroke and the quality of hypertension control in north west England. BMJ 1997; 314: 272–276.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Preventive Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan

    Suminori Kono

  2. Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan

    Toshio Kushiro

  3. Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan

    Yasunobu Hirata

  4. Faculty of Engineering, Science University of Tokyo, Tokyo, Japan

    Chikuma Hamada

  5. Health Planning Center, Nihon University School of Medicine, Tokyo, Japan

    Atsuhiko Takahashi

  6. Post-Marketing Study Department, Quality and Safety Management Division, Sankyo Co., Ltd., Tokyo, Japan

    Yuji Yoshida

Authors
  1. Suminori Kono
    View author publications

    Search author on:PubMed Google Scholar

  2. Toshio Kushiro
    View author publications

    Search author on:PubMed Google Scholar

  3. Yasunobu Hirata
    View author publications

    Search author on:PubMed Google Scholar

  4. Chikuma Hamada
    View author publications

    Search author on:PubMed Google Scholar

  5. Atsuhiko Takahashi
    View author publications

    Search author on:PubMed Google Scholar

  6. Yuji Yoshida
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Suminori Kono.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kono, S., Kushiro, T., Hirata, Y. et al. Class of Antihypertensive Drugs, Blood Pressure Status, and Risk of Cardiovascular Disease in Hypertensive Patients: A Case-Control Study in Japan. Hypertens Res 28, 811–817 (2005). https://doi.org/10.1291/hypres.28.811

Download citation

  • Received: 04 April 2005

  • Accepted: 29 August 2005

  • Issue date: 01 October 2005

  • DOI: https://doi.org/10.1291/hypres.28.811

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

  • angiotensin-converting enzyme inhibitors
  • angiotensin II receptor blockers
  • calcium channel blockers
  • cardiovascular disease
  • case-control study
Download PDF

Advertisement

Explore content

  • Research articles
  • Reviews & Analysis
  • News & Comment
  • Current issue
  • Collections
  • Sign up for alerts
  • RSS feed

About the journal

  • Journal Information
  • Open Access Fees and Funding
  • Guide to Authors
  • About the Editors
  • Message from Editors
  • Call for Paper
  • Contact
  • About the Partner
  • For Advertisers
  • Subscribe
  • Showcase of Graphical Abstracts on Hypertension Research

Publish with us

  • For Authors & Referees
  • Language editing services
  • Open access funding
  • Submit manuscript

Search

Advanced search

Quick links

  • Explore articles by subject
  • Find a job
  • Guide to authors
  • Editorial policies

Hypertension Research (Hypertens Res)

ISSN 1348-4214 (online)

ISSN 0916-9636 (print)

nature.com footer links

About Nature Portfolio

  • About us
  • Press releases
  • Press office
  • Contact us

Discover content

  • Journals A-Z
  • Articles by subject
  • protocols.io
  • Nature Index

Publishing policies

  • Nature portfolio policies
  • Open access

Author & Researcher services

  • Reprints & permissions
  • Research data
  • Language editing
  • Scientific editing
  • Nature Masterclasses
  • Research Solutions

Libraries & institutions

  • Librarian service & tools
  • Librarian portal
  • Open research
  • Recommend to library

Advertising & partnerships

  • Advertising
  • Partnerships & Services
  • Media kits
  • Branded content

Professional development

  • Nature Awards
  • Nature Careers
  • Nature Conferences

Regional websites

  • Nature Africa
  • Nature China
  • Nature India
  • Nature Japan
  • Nature Middle East
  • Privacy Policy
  • Use of cookies
  • Legal notice
  • Accessibility statement
  • Terms & Conditions
  • Your US state privacy rights
Springer Nature

© 2026 Springer Nature Limited