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 relationship of electrocardiographic left ventricular hypertrophy to decreased serum potassium
Background . Low serum potassium ( K ) is associated with increased blood pressure , impaired cardiac function and renal dysfunction . Although lower serum K is associated with cardiac hypertrophy in animal models , the relationship of low serum K to the presence and severity of electrocardiographic left ventricular hypertrophy ( LVH ) is unclear . Methods . Baseline and yearly Cornell product LVH levels were examined in relation to low serum K ( serum K ≤ 3.90 mEq/l , the lowest quartile of baseline K levels ) in 8586 patients with baseline K levels . Patients were r and omized to losartan-vs atenolol-based treatment and additional hydrochlorothiazide ( HCTZ ) therapy as needed . Results . After adjusting for age , sex , race , prior antihypertensive treatment , losartan vs atenolol therapy , HCTZ use , baseline diastolic and systolic pressure , body mass index , serum creatinine and urine albumin/creatinine ratio , baseline serum K ≤ 3.90 was associated with significantly higher mean baseline Cornell product LVH ( 2898 vs 2801 mm•ms , p = 0.001 ) and a 24 % higher risk of Cornell product LVH > 2440 mm•ms at baseline ( OR 1.24 , 95 % CI 1.11–1.38 , p < 0.001 ) . After also adjusting for baseline Cornell product and changes in diastolic and systolic pressure between baseline and each year of measurement , in-treatment serum K ≤ 3.90 determined yearly was associated with significantly higher mean Cornell product LVH at years 1–3 and with statistically significant 16–32 % increased risks of LVH by Cornell product at years 1–4 . Conclusions . A low serum K is independently associated with a greater likelihood and severity of Cornell product LVH during antihypertensive therapy
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 .