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 .
Regression of left ventricular hypertrophy in human hypertension with irbesartan
Background The Swedish irbesartan left ventricular hypertrophy investigation versus atenolol ( SILVHIA ) . Objective Angiotensin II induces myocardial hypertrophy . We hypothesized that blockade of angiotensin II subtype 1 ( AT1 ) receptors by the AT1-receptor antagonist irbesartan would reduce left ventricular mass ( as measured by echocardiography ) more than conventional treatment with a beta blocker . Design and methods This double-blind study r and omized 115 hypertensive men and women with left ventricular hypertrophy to receive either irbesartan 150 mg q.d . or atenolol 50 mg q.d . for 48 weeks . If diastolic blood pressure remained above 90 mmHg , doses were doubled , and additional medications ( hydrochlorothiazide and felodipine ) were prescribed as needed . Echocardiography was performed at weeks 0 , 12 , 24 and 48 . Results Baseline mean blood pressure was 162/104 mmHg , and mean left ventricular mass index was 157 g/m2 for men and 133 g/m2 for women . Systolic and diastolic blood pressure reductions were similar in both treatment groups . Both irbesartan ( P < 0.001 ) and atenolol ( P < 0.001 ) progressively reduced left ventricular mass index , e.g. by 26 and 14 g/m2 ( 16 and 9 % ) , respectively , at week 48 , with a greater reduction in the irbesartan group ( P = 0.024 ) . The proportion of patients who attained a normalized left ventricular mass ( i.e. ⩽ 131 g/m2 for men and ⩽ 100 g/m2 for women ) tended to be greater with irbesartan ( 47 versus 32 % , P = 0.108 ) . Conclusions Left ventricular mass was reduced more in the irbesartan group than in the atenolol group . These results suggest that blocking the action of angiotensin II at AT1-receptors may be an important mechanism , beyond that of lowering blood pressure , in the regulation of left ventricular mass and geometry in patients with hypertension
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 .