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 .
Augmentation of myocardial blood flow in hypertensive heart disease by angiotensin antagonists: a comparison of lisinopril and losartan.
OBJECTIVES The goal of this study was to compare myocardial perfusion reserve ( MPR ) before and after long-term treatment with lisinopril and losartan in patients with hypertension and left ventricular hypertrophy ( LVH ) . BACKGROUND Studies have suggested that treatment with angiotensin-converting enzyme inhibitors ( ACEIs ) improves MPR in patients with hypertension by potentiating endogenous bradykinins . Because angiotensin receptor blockers ( ARBs ) lack a direct effect on bradykinins , we hypothesized that they may not improve MPR . METHODS We measured pre- and post-treatment myocardial blood flow ( MBF ) by positron emission tomography in 17 patients ( lisinopril : 9 patients , losartan : 8 patients ) with hypertension and LVH at baseline and after coronary vasodilation with intravenous dipyridamole .  In addition , we measured rest and hyperemic blood flow in eight normotensive controls . RESULTS Post-treatment maximal coronary blood flow and MPR in the lisinopril group increased significantly compared with pretreatment values ( 3.5 + /- 1.2 vs. 2.6 + /- 1.1 ml/min/g , p = 0.02 ; 3.7 + /- 1.1 vs. 2.4 + /- 1 ml/min/g , respectively , p = 0.002 , respectively ) . Post-treatment hyperemic flow in the patients treated with lisinopril was not significantly different from corresponding measurements in controls ( 3.5 + /- 1.2 vs. 3.9 + /- 1 ml/min/g , respectively , p = NS ) . In the patients treated with losartan , there was no difference between pre- and post-treatment MBF values and MPR . CONCLUSIONS Myocardial perfusion reserve and maximal coronary flow improved in asymptomatic patients with hypertension-induced LVH after long-term treatment with lisinopril but not with losartan . Thus , ACEIs , but not ARBs , might be effective in repairing the coronary microangiopathy associated with hypertension-induced LVH
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 .