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 .
Irbesartan reduces common carotid artery intima-media thickness in hypertensive patients when compared with atenolol: the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) study.
BACKGROUND AND PURPOSE Angiotensin II promotes cell growth and has been implicated in the development and maintenance of left ventricular ( LV ) hypertrophy and of structural vascular changes . We wished to examine whether an angiotensin receptor blocker ( ARB ) would influence structural vascular changes beyond the effects of blood pressure reduction . METHODS Hypertensive patients with LV hypertrophy ( age 55 + /- 9 years , blood pressure 162 + /- 19/104 + /- 8 mmHg , LV mass index 148 + /- 31 g m(-2 ) ; mean + /- SD ) were r and omized double-blind to the ARB irbesartan ( n=52 ) or the beta(1 ) receptor blocker atenolol  ( n=56 ) for 48 weeks . Ultrasonography of the left and right common carotid artery ( CCA ) and echocardiography were performed at week 0 and 48 . RESULTS With similar reductions in blood pressure , CCA intima-media thickness ( IMT ) was reduced by irbesartan ( from 0.92 + /- 0.14 by 0.01 + /- 0.10 mm , NS ) , whereas it was increased by atenolol ( from 0.94 + /- 0.21 by 0.03 + /- 0.12 mm , P=0.018 ; P=0.002 between groups ) . CCA lumen diameter was less reduced by irbesartan than by atenolol . Thus , CCA intima-media area was reduced by irbesartan ( from 21.3 + /- 5.0 by 0.90 + /- 2.45 mm(2 ) , P=0.034 ) but not by atenolol ( from 21.3 + /- 6.1 by 0.18 + /- 2.71 mm(2 ) , NS ; P=0.037 between groups ) . Changes in CCA IMT or area did not relate to changes in LV mass . CONCLUSIONS The favourable effects by irbesartan on CCA IMT with an outward vascular remodelling suggest that angiotensin II mediates structural vascular changes , beyond the effects of blood pressure . This may be important in the prevention of cerebrovascular events
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 .