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 .
The Hong Kong diastolic heart failure study: a randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction
Background : Although heart failure with a preserved or normal ejection fraction ( HFNEF or diastolic heart failure ) is common , treatment outcomes on quality of life and cardiac function are lacking . The effect of renin – angiotensin blockade by irbesartan or ramipril in combination with diuretics on quality of life ( QoL ) , regional and global systolic and diastolic function was assessed in HFNEF patients . Methods : 150 patients with HFNEF ( LVEF > 45 % ) were r and omised to ( 1 )  diuretics alone , ( 2 ) diuretics plus irbesartan , or ( 3 ) diuretics plus ramipril .  QoL , 6-minute walk test ( 6MWT ) and Doppler echocardiography were performed at baseline , 12 , 24 and 52 weeks . Results : The QoL score improved similarly in all three groups by 52 weeks ( −46 % , 51 % , and 50 % respectively , all p<0.01 ) , although 6MWT increased only slightly ( average + 3–6 % ) . Recurrent hospitalisation rates were equal in all groups ( 10–12 % in 1 year ) . At 1 year , LV dimensions or LVEF had not changed in any group , though both systolic and diastolic blood pressures were lowered in all three groups from 4 weeks onwards . At baseline both mean peak systolic ( Sm ) and early diastolic ( Em ) mitral annulus velocities were reduced , and increased slightly in the diuretic plus irbesartan ( Sm 4.5 ( SEM 0.17 ) to 4.9 ( SEM 0.16 ) cm/sec ; Em 3.8 ( SEM 0.25 ) to 4.2 ( SEM 0.25 ) cm/sec ) and ramipril ( Sm 4.5 ( SEM 0.24 ) to 4.9 ( SEM 0.20 ) cm/sec ; Em 3.3 ( SEM 0.25 ) to 4.04 ( SEM 0.32 ) cm/sec ) groups ( both p<0.05 ) . NT-pro-BNP levels were raised at baseline ( 595 ( SD 905 ) pg/ml ; range 5–4748 ) and fell in the irbesartan ( −124 ( SD 302 ) pg/ml , p = 0.01 ) and ramipril ( −173 ( SD 415 ) pg/ml , p = 0.03 ) groups only . Conclusions : In this typically elderly group of HF patients with normal LVEF , diuretic therapy significantly improved symptoms and neither irbesartan nor ramipril had a significant additional effect . However , diuretics in combination with irbesartan or ramipril marginally improved LV systolic and diastolic longitudinal LV function , and lowered NT-proBNP over 1 year
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 .