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 .
Antihypertensive therapy and cerebral hemodynamics in executive mild cognitive impairment: results of a pilot randomized clinical trial.
OBJECTIVES To compare the effects of three antihypertensive medications on cerebral hemodynamic and cognitive function in hypertensive individuals with executive dysfunction . DESIGN Double-blind r and omized clinical trial . SETTING Community . PARTICIPANTS Fifty-three individuals aged 60 and older with hypertension and executive dysfunction . INTERVENTION Lisinopril , c and esartan , or hydrochlorothiazide for 1 year . MEASUREMENTS Cerebral blood flow velocity ( BFV ; transcranial Doppler ultrasonography during rest , sitting , st and ing , hypercapnia , and hypocapnia ) , cognition , and blood pressure were measured at baseline and after 6 and 12 months . Linear mixed models were used to compare the three groups . RESULTS Of the 53 participants , 47 had successful insonation ( mean age 72 ; 70 % white ; 57 % women ) . There was a tendency toward an increase in BFV in the c and esartan group and a decrease in the lisinopril and hydrochlorothiazide groups ( between-group P = .57 ) that was significant in those with low BFV at baseline ( < median 27.6 cm/s , between-group P = .03 ) . The c and esartan group also had the greatest improvement in executive function ( Trail Making Test Part B improved by 17.1 seconds , vs hydrochlorothiazide improved by 4.2 seconds and lisinopril worsened by 14.4 seconds , P = .008 ) . Carbon dioxide vasoreactivity and vasomotor range declined significantly in the lisinopril ( within-group P = .001 for vasoreactivity and .02 for vasomotor range ) and hydrochlorothiazide groups ( within-group P = .10 and .009 , respectively ) but not in the c and esartan group ( within-group P = .25 and .38 , respectively ; between-group P = .30 and .46 , respectively ) . CONCLUSION Angiotensin receptor blockers may preferentially preserve cerebral hemodynamics and executive function in individuals with executive dysfunction . These findings warrant further investigation in a larger trial
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 .