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 .
Renal and cardiac effects of antihypertensive treatment with ramipril vs metoprolol in autosomal dominant polycystic kidney disease.
BACKGROUND Hypertension is a common complication in autosomal dominant polycystic kidney disease ( ADPKD ) . This prospect i ve r and omized double-blind study was performed to compare the renal and cardiac effects of the ACE inhibitor ramipril and the beta-blocker metoprolol as first line therapy in ADPKD patients with hypertension . METHODS Forty-six hypertensive ADPKD patients were r and omized to either ramipril ( n = 23 ) or metoprolol ( n = 23 ) . Twenty-four hour ( 24-h ) ambulatory blood pressure ( BP ) , glomerular filtration rate ( GFR ) as calculated by the Cockcroft and Gault formula , urinary albumin excretion ( albumin/creatinine ratio ) , and left ventricular mass index ( LVMI ) were established at baseline and at yearly intervals . The total follow-up was 3 years . Baseline characteristics were similar in both groups . RESULTS Mean arterial pressure ( MAP ) decreased significantly in both the ramipril and the metoprolol group (-8 + /- 2 and -6 + /- 2 mmHg ; both P < 0.01 ) . There was a significant decline in renal function during follow-up which was similar in patients treated with ramipril or metoprolol ( -2.5 + /- 0.7 vs -2.9 + /- 0.8 ml/min/year ; P = NS ) . After the 3 years follow-up , no differences in GFR , LVMI and urinary albumin excretion were observed between the ramipril and the metoprolol group ( 80.7 + /- 10.7 vs 78.0 + /- 7.6 ml/min , 102.6 + /- 6.8 vs 100.3 + /- 5.4 g/m(2 ) ; and 42.6 + /- 12.3 vs 70.3 + /- 32.5 mg/g , respectively ; all P = NS ) . A post-hoc analysis evaluating the effects of BP control , revealed that LVMI increased in patients with st and ard BP control while it remained stable in patients with rigorous BP control with a significant difference in LVMI between the groups after 3 years of follow-up ( 110.5 + /- 6.3 vs 90.9 + /- 4.7 g/m(2 ) ; P = 0.017 ) . Also , by the end of the study albuminuria was lower in patients with rigorous vs st and ard BP control ( 23.5 + /- 6.7 vs 94.8 + /- 35.4 mg/g ; P = 0.05 ) . CONCLUSIONS In our study population of hypertensive ADPKD patients , no differences in renal function , urinary albumin excretion and LVMI were detected between those treated with ramipril or metoprolol , respectively , during a 3 years follow-up . Rigorous BP control prevented an increase in LVMI and reduced urinary albumin excretion , suggesting a crucial role of BP control for slowing progression of cardiac and renal organ damage in ADPKD
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 .