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 nitrendipine and enalapril on left ventricular mass in patients with non‐insulin‐dependent diabetes mellitus and hypertension
Objective To compare the effects of a calcium antagonist ( nitrendipine ) and an angiotensin converting enzyme inhibitor ( enalapril ) with those of placebo on left ventricular mass in patients with non-insulin-dependent diabetes mellitus and hypertension . Design A double-blind r and omized , placebo-controlled trial . Setting General practitioners referred patients to the trial physician . Patients The study population comprised 121 patients with non-insulin-dependent diabetes mellitus . Inclusion criteria for blood pressure were diastolic blood pressure 90–115 mmHg and systolic blood pressure ⩽ 200 mmHg , while subjects were not being administered blood-pressure-lowering drugs for 3 weeks . Intervention Patients were r and omly allocated to receive nitrendipine ( n = 40 ) , enalapril ( n = 40 ) or placebo ( n = 41 ) . The treatment period was 48 weeks . Main outcome measures The effect of nitrendipine was defined as the difference in change in left ventricular mass index from baseline between nitrendipine treatment and placebo after 48 weeks of treatment . The effects of nitrendipine compared with that of enalapril and of enalapril compared with placebo were defined similarly . Left ventricular mass was measured by M-mode echocardiography . Results Use of nitrendipine and enalapril led to significant and almost identical reductions in systolic and diastolic blood pressures . During 48 weeks left ventricular mass index decreased by 5 % for patients in the nitrendipine group ( decrease by 12 g/m2 , 95 % confidence interval 1–23 ) , remained about the same for patients in the enalapril group ( decrease by 1 g/m2 , 95 % confidence interval decrease by 10 to increase by 9 ) and increased by 9 % for patients in the placebo group ( increase by 9 g/m2 , 95 % confidence interval 2–16 ) . Conclusion These results indicate that administration of nitrendipine to patients with non-insulin-dependent diabetes mellitus and hypertension  reduces left ventricular mass index . Enalapril appears not to induce regression , but perhaps prevents progression with an effect that is intermediate between those of nitrendipine and placebo . J Hypertens 16:689–696 © 1998 Lippincott-Raven Publishers
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 .