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 .
Long-Term Effects of Irbesartan and Atenolol on the Renin-Angiotensin-Aldosterone System in Human Primary Hypertension: The Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA)
We examined long-term influence of the angiotensin II type 1-receptor blocker irbesartan and the beta1-adrenergic receptor blocker atenolol on some neurohormonal systems implicated in the pathophysiology of cardiac hypertrophy . Thus , 115 hypertensive patients with left ventricular hypertrophy were r and omized to receive double-blind irbesartan or atenolol , with additional therapy if needed . Neurohormone measurements and echocardiography were performed at weeks 0 , 12 , 24 , and 48 . Left ventricular mass was reduced more by irbesartan than by atenolol ( −26 g/m2 versus −14 g/m2 , P = 0.024 ) , despite similar reductions in blood pressure . Plasma renin activity and angiotensin II increased ( P < 0.001 ) by irbesartan ( 0.9 ± 0.7 to 3.4 ± 4.2 ng/mL × h , and 3.0 ± 1.6 to 13.0 ± 17.7 pmol/L ) , but decreased ( P < 0.01 ) by atenolol ( 1.0 ± 0.6 to 0.7 ± 0.6 ng/mL × h , and 3.4 ± 1.6 to 3.2 ± 2.2 pmol/L ) . Serum aldosterone decreased ( P < 0.05 ) by both irbesartan ( 346 ± 140 to 325 ± 87 pmol/L ) and atenolol ( 315 ± 115 to 283 ± 77 pmol/L ) . Changes in left ventricular mass  by irbesartan related inversely to changes in plasma renin activity , angiotensin II , and aldosterone ( all P < 0.05 ) . Plasma levels and 24-hour urinary excretions of catecholamines , plasma leptin , proinsulin , insulin and insulin sensitivity remained largely unchanged in both groups . Thus , the renin-angiotensin aldosterone system appears to be an important non-hemodynamic factor in the regulation of left ventricular mass
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 .