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 .
The effects of losartan compared to atenolol on stroke in patients with isolated systolic hypertension and left ventricular hypertrophy. The LIFE study.
The Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study reported that a losartan-based antihypertensive regimen reduced cardiovascular morbidity and mortality ( composite of cardiovascular death , stroke , and myocardial infa rct ion ) more than therapy based on atenolol in patients with left ventricular hypertrophy and isolated systolic hypertension ( ISH ) . Patients aged 55 - 80 years with blood pressures 160 - 200/<90 mm Hg were followed for a mean of 4.7 years .  Blood pressure was similarly reduced in the losartan ( n=660 ) and atenolol ( n=666 ) ISH groups . There were 88 ( 6.6 % ) patients who experienced a stroke , 18 of which were fatal . Of patients experiencing strokes , 72.7 % had an ischemic stroke .  ISH patients in LIFE compared to the non-ISH group had a higher incidence of any stroke and embolic stroke , and similar incidences of fatal , atherosclerotic , and hemorrhagic/other strokes . The incidence of any stroke ( 40 % risk reduction [ RR ] , p=0.02 ) , fatal stroke ( 70 % RR , p=0.035 ) , and atherothrombotic stroke ( 45 % RR , p=0.022 ) was significantly lower in losartan-treated compared to the atenolol-treated patients . The 36 % RR for embolic strokes in the losartan group was not statistically significantly ( p=0.33 ) different from the atenolol group . These data suggest that losartan-based treatment is more effective than an atenolol-based treatment for patients with ISH and a high risk for stroke
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 .