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 .
The effect of losartan versus atenolol on cardiovascular morbidity and mortality in patients with hypertension taking aspirin: the Losartan Intervention for Endpoint Reduction in hypertension (LIFE) study.
OBJECTIVES We conducted a subgroup analysis in the Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study to determine whether aspirin interacted with the properties of losartan , an angiotensin-II receptor antagonist . BACKGROUND Negative interactions between angiotensin-converting enzyme inhibitors and aspirin have been reported . There are no data reported from clinical trials about possible interactions between angiotensin-II receptor antagonists and aspirin . METHODS The LIFE study assigned 9,193 patients with hypertension and left ventricular hypertrophy ( LVH ) to losartan- or atenolol-based therapy for a mean of 4.7 years , with 1,970 ( 21.4 % ) taking aspirin at baseline . The primary composite end point ( CEP ) included cardiovascular death , stroke , and myocardial infa rct ion ( MI ) . The present cohort was stratified by aspirin use at baseline . RESULTS Blood pressures were reduced similarly in the losartan with aspirin ( n = 1,004 ) and atenolol with aspirin ( n = 966 ) groups . The CEP was reduced by 32 % ( 95 % confidence interval 0.55 to 0.86 , p = 0.001 ) with losartan with aspirin compared to atenolol with aspirin , adjusted for Framingham risk score and LVH . The test for treatment versus aspirin interaction , excluding other covariates , was significant for the CEP ( p = 0.016 ) and MI ( p = 0.037 ) . CONCLUSIONS There was a statistical interaction between treatment and aspirin in the LIFE study , with significantly greater reductions for the CEP and MI with losartan in patients using aspirin than in patients not using aspirin at baseline . Further studies are needed to clarify whether this represents a pharmacologic interaction or a selection by aspirin use of patients more likely to respond to losartan treatment
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 .