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 .
Effects of antihypertensive drugs losartan and levamlodipine besylate on insulin resistance in patients with essential hypertension combined with isolated impaired fasting glucose
The objective of this study was to observe the antihypertensive effect of losartan and levamlodipine besylate on insulin resistance in patients with essential hypertension ( EH ) combined with isolated impaired fasting glucose ( i-IFG ) . Patients ( n=244 ) were r and omly assigned to losartan potassium tablets ( 50–100 mg per day ) or levamlodipine besylate tablets ( 2.5–5.0 mg per day ) for intensive antihypertensive treatment with no lifestyle interventions for 3 years . The changes in fasting plasma glucose , fasting insulin ( FINS ) and insulin sensitivity index ( ISI ) from before to after treatment were observed . Blood pressure ( BP ) in each group was significantly reduced by treatment ( P<0.05 ) . After 12 months of treatment , the FINS level in the losartan potassium group was significantly decreased and ISI was significantly increased compared with before treatment ( P<0.05 ) and compared with the levamlodipine besylate group ( P<0.05 ) . After 24 and 36 months of treatment , FINS was significantly decreased and ISI was significantly improved in both groups compared with baseline ( P<0.05 ) , and there was no difference between the groups ( P>0.05 ) . The incidence of new-onset diabetes mellitus was not significantly different between two groups . The antihypertensive effect of losartan and levamlodipine besylate could amoliorate insulin resistance in patients with EH combined with i-IFG . The improvement of insulin resistance by losartan potassium at 12 months might be better than that by levamlodipine besylate ; however , after 24 and 36 months of follow-up , both agents significantly alleviated insulin resistance . These results suggest that the effects of these two drugs on insulin resistance are not significantly different
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 .