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 .
Long-term comparison of losartan and enalapril on kidney function in hypertensive type 2 diabetics with early nephropathy.
BACKGROUND The objectives of this study were to compare the effects of the angiotensin II receptor blocker , losartan , to those of the angiotensin-converting enzyme inhibitor , enalapril , on albuminuria and renal function in relationship to clinic and ambulatory blood pressure ( ABP ) in hypertensive type 2 diabetic subjects with early nephropathy . The tolerability of these agents and their effect on the metabolic profile were also evaluated . METHODS The study was a one-year prospect i ve , double-blind trial with losartan and enalapril administered alone or in combination with hydrochlorothiazide and other antihypertensive agents .  ABP and renal and biochemical parameters were measured at baseline and after 12 , 28 , and 52 weeks of active treatment . Ninety-two hypertensive type 2 diabetics with early nephropathy completed the study . RESULTS Both losartan and enalapril administered alone or in combination with other agents induced significant reductions in sitting clinic ( P < 0.05 ) and ABP ( P < 0.002 ) without a statistical difference between groups . Geometric means for urinary albumin excretion ( UAE ) decreased significantly ( P < 0.001 ) in patients treated with losartan from 64 . 1 to 41.5 microg/min and in those treated with enalapril from 73.9 to 33.5 microg/min after 52 weeks of therapy . A significant relationship ( P < 0.05 ) between changes in systolic and diastolic ABP and the decrease in UAE at 52 weeks was seen in both groups . The decline in glomerular filtration rate ( GFR ) was stabilized at the end of therapy and was identical in both treatment groups . Treatment with enalapril was associated with a significantly higher incidence of cough ( P = 0.006 ) and a rise in serum uric acid ( P = 0.002 ) compared with losartan . CONCLUSIONS Our results indicate that a one-year course of antihypertensive therapy with either losartan or enalapril significantly reduces UAE in hypertensive type 2 diabetic patients with early nephropathy . The reduction in UAE with each treatment is similarly related to decrements in ABP . In addition , the rate of decline in GFR is similar in both treatment groups
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 .