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 .
Pulse pressure, left ventricular function and cardiovascular events during antihypertensive treatment (the LIFE study)
Abstract Background . Pulse pressure ( PP ) has been related to risk of cardiovascular events in hypertension . However , less is known about modification of this risk marker during antihypertensive treatment in patients with left ventricular ( LV ) hypertrophy . Methods . Associations of in-treatment PP with LV systolic function and cardiovascular events was assessed in 883 patients with electrocardiographic LV hypertrophy during 4.8 years of r and omized losartan- or atenolol-based treatment within the echocardiographic sub study of the Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study . Results . PP was similarly reduced by both treatments . In different multiple regression models , lower in-treatment PP was independently associated with lower in-treatment LV ejection fraction ( β=0.16 ) , stress-corrected midwall shortening ( β=0.20 ) , stroke volume ( β=0.11 ) and cardiac index ( β=0.07 , all p<0.05 ) . In time-varying Cox regression models , 10mmHg lower in-treatment PP was associated with a 28 % higher rate of cardiovascular events [ hazard ratio , HR = 1.28 ( 1.09 – 1.52 ) , p<0.01 ] independent of in-treatment LV mass and ejection fraction , history of ischemic heart disease , Framingham risk score and study treatment allocation . Conclusion . During systematic antihypertensive treatment in hypertensive patients with electrocardiographic LV hypertrophy , lower in-treatment PP was associated with lower in-treatment LV function and cardiac output as well as higher rate of cardiovascular events
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 .