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 single-drug therapy on reduction of left atrial size in mild to moderate hypertension: comparison of six antihypertensive agents.
BACKGROUND Cardiac effects of hypertension include increased left ventricular ( LV ) mass and LV hypertrophy , as well as increased left atrial size , a predictor of stroke and atrial fibrillation . Although literature on reduction of LV mass with antihypertensive therapy is extensive , little information is available on effects of treatment on left atrial size . METHODS AND RESULTS Patients with mild to moderate hypertension ( diastolic blood pressure 95 to 109 mm Hg ) were r and omly allocated to treatment with atenolol , captopril , clonidine , diltiazem , hydrochlorothiazide , or prazosin in a double-masked trial . Two-dimensional targeted M-mode echocardiography was used to assess left atrial size and LV mass at baseline , 8 weeks , and 1 and 2 years . Longitudinal analysis examined changes in left atrial size from the baseline study , statistically adjusting for age , race , pretreatment left atrial size and LV mass , and serial measurements of systolic blood pressure , body weight , urinary sodium excretion , and physical activity score . Without adjustment for covariates , only hydrochlorothiazide was associated with decreases in left atrial size from baseline at 8 weeks ( -1.0 + /- 5.2 mm ; P=0.052 ) , 1 year ( -2.0 + /- 5.1 mm ; P=0.02 ) , and 2 years ( 4.6+/-7.2 mm ; P=0.002 ) . After adjustment for effects of covariates , patients with normal left atrial size had greater reduction ( -3.3 mm ) in left atrial size at 2 years with hydrochlorothiazide than with any other drug . For patients with left atrial enlargement , left atrial size decreased significantly with hydrochlorothiazide , atenolol , clonidine , and diltiazem at 1 year and with all treatments at 2 years . However , reduction at 2 years was greater with hydrochlorothiazide than with captopril or prazosin . CONCLUSIONS Antihypertensive drugs differ in their effects on left atrial size .  Hydrochlorothiazide was associated with greater overall reduction of left atrial size than other drugs effective for the treatment of hypertension . Reduction of left atrial size with therapy is in part independent of factors known to influence left atrial size , including LV mass and reduction of LV mass with treatment . The clinical benefit of reducing left atrial size with antihypertensive treatment remains to be determined
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 .