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 .
Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: The NESTOR* study
Objectives To test whether microalbuminuria in patients with type 2 diabetes and hypertension is primarily dependent on the severity of hypertension , and to compare the effectiveness of two antihypertensive drugs with opposite effects on the renin – angiotensin system [ the diuretic , indapamide sustained release ( SR ) , and an angiotensin-converting enzyme inhibitor , enalapril ] in reducing microalbuminuria . Design A multinational , multicentre , controlled , double-blind , double-dummy , r and omized , two-parallel-groups study over 1 year . Methods After a 4-week placebo run-in period , 570 patients ( ages 60.0 ± 9.9 years , 64 % men ) with type 2 diabetes , essential hypertension [ systolic blood pressure ( SBP ) 140–180 mmHg , and diastolic blood pressure ( DBP ) < 110 mmHg ] , and persistent microalbuminuria ( 20–200 μg/min ) were allocated r and omly to groups to receive indapamide SR 1.5 mg ( n = 284 ) or enalapril 10 mg ( n = 286 ) once a day . Amlodipine , atenolol , or both were added , if necessary , to achieve the target blood pressure of 140/85 mmHg . Results There was a significant reduction in the urinary albumin : creatinine ratio . Mean reductions were 35 % [ 95 % confidence interval ( CI ) 24 to 43 ] and 39 % ( 95 % CI 30 to 47 % ) in the indapamide SR and enalapril groups , respectively . Equivalence was demonstrated between the two groups [ 1.08 ( 95 % CI 0.89 to 1.31 % ) ; P = 0.01 ] . The reductions in mean arterial pressure ( MAP ) were 16.6 ± 9.0 mmHg for the indapamide SR group and 15.0 ± 9.1 mmHg for the enalapril group ( NS ) ; the reduction in SBP was significantly greater ( P = 0.0245 ) with indapamide SR . More than 50 % of patients in each group required additional antihypertensive therapy , with no differences between groups . Both treatments were well tolerated . Conclusions Indapamide-SR-based therapy is equivalent to enalapril-based therapy in reducing microalbuminuria with effective blood pressure reduction in patients with hypertension and type 2 diabetes
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 .