Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .
Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial.
BACKGROUND Present angiotensin-converting-enzyme inhibitor treatment fails to prevent progression of non-diabetic renal disease . We aim ed to assess the efficacy and safety of combined treatment of angiotensin-converting-enzyme inhibitor and angiotensin-II receptor blocker , and monotherapy of each drug at its maximum dose , in patients with non-diabetic renal disease . METHODS 336 patients with non-diabetic renal disease were enrolled from one renal outpatient department in Japan . After screening and an 18-week run-in period , 263 patients were r and omly assigned angiotensin-II receptor blocker ( losartan , 100 mg daily ) , angiotensin-converting-enzyme inhibitor ( tr and olapril , 3 mg daily ) , or a combination of both drugs at equivalent doses .  Survival analysis was done to compare the effects of each regimen on the combined primary endpoint of time to doubling of serum creatinine concentration or end-stage renal disease . Analysis was by intention to treat . FINDINGS Seven patients discontinued or were otherwise lost to follow-up . Ten ( 11 % ) of 85 patients on combination treatment reached the combined primary endpoint compared with 20 ( 23 % ) of 85 on tr and olapril alone ( hazard ratio 0.38 , 95 % CI 0.18 - 0.63 , p=0.018 ) and 20 ( 23 % ) of 86 on losartan alone ( 0.40 , 0.17 - 0.69 , p=0.016 ) . Covariates affecting renal survival were combination treatment ( hazard ratio 0.38 , 95 % CI 0.18 - 0.63 , p=0.011 ) , age ( 1.30 , 1.03 - 2.29 , p=0.009 ) , baseline renal function ( 1.80 , 1.02 - 2.99 , p=0.021 ) , change in daily urinary protein excretion rate ( 0.58 , 0.24 - 0.88 , p=0.022 ) , use of diuretics ( 0.80 , 0.30 - 0.94 , p=0.043 ) , and antiproteinuric response to tr and olapril ( 0.81 , 0.21 - 0.91 , p=0.039 ) . Frequency of side-effects with combination treatment was the same as with tr and olapril alone . INTERPRETATION Combination treatment safely retards progression of non-diabetic renal disease compared with monotherapy . However , since some patients reached the combined primary endpoint on combined treatment , further strategies for complete management of progressive non-diabetic renal disease need to be research ed
Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .