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 .
Large and small artery endothelial function in patients with essential hypertension – Effect of ACE inhibition and beta‐blockade
Hypertension has been associated with changes in endothelial function in both large muscular arteries and small resistance arteries . We evaluated the relationship between blood flow velocity and dilatation of the brachial artery following transient forearm ischemia and acetylcholine‐induced relaxation in subcutaneous small arteries and the influence of antihypertensive therapy on both in patients with essential hypertension . Thirty‐one previously untreated hypertensive patients were r and omized in a double‐blind fashion to treatment with either the angiotensin‐converting enzyme ( ACE ) inhibitor perindopril or the beta‐blocker atenolol and compared with 17 healthy normotensive controls . Before and after 1 year of treatment , while still on active medication , flow‐mediated dilatation ( FMD ) was measured in the brachial artery using ultrasound while relaxation to acetylcholine in small arteries was tested in vitro in a myograph . FMD correlated inversely to resting brachial artery diameter ( r = −0.38 , p<0.05 ) . FMD corrected for resting diameter ( FMDcorr ) was lower in patients ( 3.0±0.2 % ) compared with controls ( 4.2±0.3 % , p<0.01 ) . In both patients and controls , FMDcorr was related to flow velocity in a non‐linear way with FMDcorr reaching a maximum despite increasing flow velocities , and in the patients , FMDcorr was only reduced at high flow velocities . Furthermore , patients had a reduced acetylcholine‐induced relaxation in small arteries ( p = 0.04 ) . Perindopril and atenolol  reduced blood pressure to similar levels and both drugs improved FMDcorr to a similar degree without any effects on relaxation to acetylcholine in small arteries . The present study demonstrates the role of correcting for differences in baseline diameter during measurements of FMD and a non‐linear relationship between flow velocity and FMD in the brachial artery . Furthermore , the results suggest different effects of antihypertensive treatment on endothelial function in large and small arteries
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 .