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 .
Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial
BACKGROUND ACE inhibitors attenuate the detrimental effects of angiotensin II , and improve survival and reduce morbidity in patients with acute myocardial infa rct ion and evidence of heart failure or left-ventricular dysfunction . Selective antagonism of the angiotensin type 1 receptor represents an alternative approach to inhibition of the renin-angiotensin system . We did a multicentre , r and omised trial to test the hypothesis that the angiotensin II antagonist losartan would be superior or non-inferior to the ACE inhibitor captopril in decreasing all-cause mortality in high-risk patients after acute myocardial infa rct ion . METHODS 5477 patients 50 years of age or older ( mean age 67.4 years [ SD 9.8 ] ) , with confirmed acute myocardial infa rct ion and heart failure during the acute phase or a new Q-wave anterior infa rct ion or reinfa rct ion , were recruited from 329 centres in seven European countries . Patients were r and omly assigned and titrated to a target dose of losartan ( 50 mg once daily ) or captopril ( 50 mg three times daily ) as tolerated . The primary endpoint was all-cause mortality . Analysis was by intention to treat . FINDINGS There were 946 deaths during a mean follow-up of 2.7 ( 0.9 ) years : 499 ( 18 % ) in the losartan group and 447 ( 16 % ) in the captopril group ( relative risk 1.13 [ 95 % CI 0.99 - 1.28 ] , p=0.07 ) . The results for the secondary and tertiary endpoints were as follows : sudden cardiac death or resuscitated cardiac arrest 239 ( 9 % ) versus 203 ( 7 % ) , 1.19 ( 0.98 - 1.43 ) , p=0.07 , and fatal or non-fatal reinfa rct ion 384 ( 14 % ) versus 379 ( 14 % ) , 1.03 ( 0.89 - 1.18 ) , p=0.72 . The all-cause hospital admission rates were 1806 ( 66 % ) versus 1774 ( 65 % ) , 1.03 ( 0.97 - 1.10 ) , p=0.37 . Losartan was significantly better tolerated than captopril , with fewer patients discontinuing study medication ( 458 [ 17 % ] vs 624 [ 23 % ] , 0.70 [ 0.62 - 0.79 ] , p<0.0001 ) . INTERPRETATION Since we saw a non-significant difference in total mortality in favour of captopril , ACE inhibitors should remain first-choice treatment in patients after complicated acute myocardial infa rct ion .  Losartan can not be generally recommended in this population . However , it was better tolerated than captopril , and was associated with significantly fewer discontinuations . Although the role of losartan in patients intolerant of ACE inhibition is not clearly defined , it can be considered in such patients
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 .