We found predominantly moderate quality evidence that all-cause mortality is similar when first-line RAS inhibitors are compared to other first-line antihypertensive agents .
First-line thiazides caused less HF and stroke than first-line RAS inhibitors .
Compared with first-line CCBs , first-line RAS inhibitors reduced HF but increased stroke .
The magnitude of the reduction in HF exceeded the increase in stroke .
The small differences in effect on blood pressure between the different classes of drugs did not correlate with the differences in the primary outcomes
BACKGROUND Renin-angiotensin system ( RAS ) inhibitors are widely prescribed for treatment of hypertension , especially for diabetic patients on the basis of postulated advantages for the reduction of diabetic nephropathy and cardiovascular morbidity and mortality .
Despite widespread use of angiotensin converting enzyme ( ACE ) inhibitors and angiotensin receptor blockers ( ARBs ) for hypertension in both diabetic and non-diabetic patients , the efficacy and safety of RAS inhibitors compared to other antihypertensive drug classes remains unclear .
OBJECTIVES To evaluate the benefits and harms of first-line RAS inhibitors compared to other first-line antihypertensive drugs in patients with hypertension .
Comparison of losartan and hydrochlorothiazide on cognitive function and quality of life in hypertensive patients.
We examined long-term changes in cognitive function and quality of life ( QL ) in hypertensive patients by comparing the antihypertensive effect of hydrochlorothiazide ( HCTZ ) and losartan . We studied 69 patients ( age range , 30 to 73 years ) with mild-to-moderate hypertension . All patients , in a double-blind study , were r and omly allocated to either treatment with 50 mg losartan once daily or 25 mg HCTZ once daily . The sample in each treatment group was divided by age ( younger than 60 years or 60 years or older ) . At baseline and after 26 months , a QL question naire appropriate for the hypertensive patients was given . Cognitive function was evaluated , at baseline and after 26 months , by psychometric tests consisting of items from the  Mini-Mental State Examination ( MMSE ) and the S and oz Clinical Assessment Geriatric ( SCAG ) . A score of less than 24 on the MMSE and more than 40 on the SCAG was predictive of cognitive impairment . The losartan group had a significant improvement in SCAG ( P<.001 ) and MMSE ( P<.001 ) . No significant changes were observed in the HCTZ group ( SCAG , P = .1 ; MMSE , P = .2 ) . Sixty-five percent of the elderly had a MMSE score less than 24 and 70 % had a SCAG score greater than 40 , v. 35 % and 48 % , respectively , in younger patients . The health state index of QL improved significantly in both groups ( losartan group , P<.01 ; HCTZ group , P<.02 ) ; the improvement in QL scores in patients using HCTZ was significant only in subjects aged 60 years and older ( P<.04 ) . These results suggest that losartan can have a positive effect not only on blood pressure but also on impaired cognitive function , reversing even minimal cognitive deficits induced by hypertension . The elderly patients in our sample had worse scores and cognitive performance was lower than in younger patients , even if in the losartan group the score improvement was the same at all ages . The same could not be said for HCTZ
We found predominantly moderate quality evidence that all-cause mortality is similar when first-line RAS inhibitors are compared to other first-line antihypertensive agents .
First-line thiazides caused less HF and stroke than first-line RAS inhibitors .
Compared with first-line CCBs , first-line RAS inhibitors reduced HF but increased stroke .
The magnitude of the reduction in HF exceeded the increase in stroke .
The small differences in effect on blood pressure between the different classes of drugs did not correlate with the differences in the primary outcomes
BACKGROUND Renin-angiotensin system ( RAS ) inhibitors are widely prescribed for treatment of hypertension , especially for diabetic patients on the basis of postulated advantages for the reduction of diabetic nephropathy and cardiovascular morbidity and mortality .
Despite widespread use of angiotensin converting enzyme ( ACE ) inhibitors and angiotensin receptor blockers ( ARBs ) for hypertension in both diabetic and non-diabetic patients , the efficacy and safety of RAS inhibitors compared to other antihypertensive drug classes remains unclear .
OBJECTIVES To evaluate the benefits and harms of first-line RAS inhibitors compared to other first-line antihypertensive drugs in patients with hypertension .