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 .
Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive Type 2 diabetic patients with microalbuminuria: DIAL study (diabete, ipertensione, albuminuria, lercanidipina).
Microalbuminuria and hypertension are risk factors for diabetic nephropathy in Type 2 diabetic patients . Recent data suggest that blockade of the renin-angiotensin system slows the progression of diabetic nephropathy ; in contrast , the results on the renoprotective effect of calcium channel antagonists are conflicting . We evaluated the effectiveness of lercanidipine , in comparison with ramipril , on the reduction in albumin excretion rate ( AER ) and blood pressure in mild-to-moderate hypertensive patients with Type 2 diabetes and persistent microalbuminuria . A total of 277 patients were enrolled in a multicentric , r and omized , double-blind , active-controlled , parallel-group trial ; 180 were r and omized to receive 10 - 20 mg/day of  lercanidipine or 5 - 10 mg/day of ramipril and followed up for 9 - 12 months . The primary outcome was the change in AER from baseline . After 9 - 12 months of follow-up , a reduction in AER of -17.4+/-65 microg/min ( p<0.05 ) and -19.7+/-52.5 ( p<0.05 ) in the lercanidipine and ramipril group , respectively , was observed , without differences between the groups . A significant reduction in systolic and diastolic blood pressure was observed in both the lercanidipine and ramipril-based treatment groups ( p<0.0001 for both ) . This study demonstrated that treatment with lercanidipine 10 - 20 mg/day does not worsen albuminuria in microalbuminuric Type 2 diabetic patients with hypertension . Indeed , both lercanidipine and ramipril treatments result ed in a significant reduction in AER without a statistically significant difference between the two groups
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 .