Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .
Comparison of telmisartan with lisinopril in patients with mild-to-moderate hypertension.
In this study , telmisartan , a new angiotensin AT ( 1 ) receptor antagonist given as monotherapy and in combination with hydrochlorothiazide ( HCTZ ) , was compared with lisinopril as monotherapy and in combination with HCTZ . This 52-week , r and omized , multicenter , double-blind , double-dummy , parallel-group , dose-titration study of 578 patients with mild-to-moderate essential hypertension ( mean diastolic blood pressure [ DBP ] , > /=95 mm Hg ) , compared the efficacy and safety of telmisartan ( n = 385 ) with lisinopril ( n = 193 ) . Dosage could be increased for both telmisartan ( 40 -- > 80 -- > 160 mg ) and lisinopril ( 10 -- > 20 -- > 40 mg ) at each of the first 2 monthly visits if DBP control ( < 90 mm Hg ) had not been established . Once DBP control was established , patients entered the 48-week maintenance period . During this period , the dose of the study drug was fixed , although open-label HCTZ at 12.5 mg or 25 mg was added , when needed , to regain DBP control . At the end of the titration period , DBP control was achieved on monotherapy by 67 % and 63 % of the telmisartan and lisinopril patients , respectively . At the end of the maintenance period , supine DBP was controlled in 83 % and 87 % of the telmisartan and lisinopril patients , respectively , with systolic blood pressure over DBP reductions of 23.8/16.6 mm Hg for telmisartan and 19.9/15.6 mm Hg for lisinopril .  Treatment-related side effects occurred in fewer telmisartan-treated patients ( 28 % ) than in lisinopril-treated patients ( 40 % ; P = .001 ) . Significantly fewer patients ( P = .018 ) receiving telmisartan experienced treatment-related cough ( 3 % v 7 % ) , and cough led to discontinuation significantly less often ( P = .007 ) with telmisartan treatment than with lisinopril treatment ( 0.3 % v 3.1 % ) . In addition , two cases of angioedema were observed , both in the lisinopril group . The selective AT ( 1 ) receptor antagonist , telmisartan , is extremely effective in the treatment of mild-to-moderate hypertension both as monotherapy and in combination with HCTZ and is at least comparable in efficacy to lisinopril , with a tolerability profile that may offer advantages in terms of a reduced incidence of adverse events
Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .