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 .
Effects of enalapril/lercanidipine combination on some emerging biomarkers in cardiovascular risk stratification in hypertensive patients.
WHAT IS KNOWN AND OBJECTIVE There is considerable interest in pharmacogenetic and molecular biomarkers . Our aim was to evaluate the effects of enalapril/lercanidipine combination on some emerging biomarkers for cardiovascular risk stratification of hypertensive patients , such as lipoprotein(a ) [ Lp(a ) ] , soluble advanced glycation end products ( sRAGE ) , soluble CD40 lig and ( sCD40L ) and serum myeloperoxidase ( MPO ) . RESEARCH DESIGN AND METHODS Three hundred and forty-five patients were enrolled in this r and omized , double-blind , clinical trial : 120 hypertensive patients were r and omized to enalapril 20 mg , 110 to lercanidipine 10 mg and 115 to enalapril/lercanidipine 20/10 mg fixed combination .  We measures the following markers at baseline and after 6 , 12 , 18 and 24 months : blood pressure , fasting plasma glucose ( FPG ) , lipid profile , Lp(a ) , sRAGE , sCD40L and MPO . RESULTS There was a decrease in blood pressure in all groups compared with baseline , even if , as expected , enalapril/lercanidipine combination was more effective in reducing blood pressure compared with the monotherapies . No variations in lipid profile or FPG were recorded in any of the groups . Lercanidipine , but not enalapril , improved Lp(a ) levels compared with baseline . The combination enalapril/lercanidipine improved it more than the single therapies . All treatments increased sRAGE levels , and decreased sCD40L and MPO , with a better effect seen with the enalapril/lercanidipine combination compared with single monotherapies . WHAT IS NEW AND CONCLUSION The combination enalapril/lercanidipine seems to be better than the single monotherapies in reducing not only blood pressure , but also the levels of some emerging biomarkers , potentially useful for cardiovascular risk stratification of hypertensive patients
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 .