There was no clear evidence that proportional risk reductions in major cardiovascular disease differed by baseline disease history , except for diabetes and chronic kidney disease , for which smaller , but significant , risk reductions were detected .
β blockers were inferior to other drugs for the prevention of major cardiovascular disease events , stroke , and renal failure .
Calcium channel blockers were superior to other drugs for the prevention of stroke .
For the prevention of heart failure , calcium channel blockers were inferior and diuretics were superior to other drug classes .
INTERPRETATION Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities .
BACKGROUND The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established .
However , the extent to which these effects differ by baseline blood pressure , presence of comorbidities , or drug class is less clear .
We therefore performed a systematic review and meta- analysis to clarify these differences .
The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT).
OBJECTIVES We attempted to compare the effect of an angiotensin-converting enzyme ( ACE ) inhibitor and angiotensin receptor blocker ( ARB ) on  atherosclerotic events . BACKGROUND Angiotensin-converting enzyme inhibitors and ARBs interrupt the renin-angiotensin system by distinct mechanisms . It is not clear whether ARBs reduce atherosclerotic events such as myocardial infa rct ion ( MI ) like ACE inhibitors . This evidence gap may reflect the nature of the studies conducted , to date . Placebo-controlled studies enrolled cohorts at low risk of atherosclerotic events ( e.g. , patients with chronic heart failure , most treated with an ACE inhibitor ) . One of the main active controlled trials was confounded by a blood pressure difference between treatments . METHODS We compared the effects of captopril , valsartan , and their combination on atherosclerotic events in 14,703 patients r and omized in the Valsartan in Acute Myocardial Infa rct ion Trial ( VALIANT ) . RESULTS The number of individuals adjudicated as having a fatal or non-fatal MI in the captopril group was 559 ( total investigator reported events 798 ) , 587 ( 796 ) in the valsartan group , and 554 ( 756 ) in the combination group ; valsartan versus captopril , p = 0.651 ( 0.965 ) ; combination versus captopril , p = 0.187 ( 0.350 ) . Overall , all atherosclerotic events examined occurred at a similar frequency in the captopril and valsartan groups . CONCLUSIONS Angiotensin receptor blockers appear to be as effective as ACE inhibitors in reducing atherosclerotic events , even when used in addition to other secondary preventive treatments . These data , although not conclusive , also support the hypothesis that adding an ARB to an ACE inhibitor may have a small additional anti-infa rct ion effect , a possibility that needs to be prospect ively tested
There was no clear evidence that proportional risk reductions in major cardiovascular disease differed by baseline disease history , except for diabetes and chronic kidney disease , for which smaller , but significant , risk reductions were detected .
β blockers were inferior to other drugs for the prevention of major cardiovascular disease events , stroke , and renal failure .
Calcium channel blockers were superior to other drugs for the prevention of stroke .
For the prevention of heart failure , calcium channel blockers were inferior and diuretics were superior to other drug classes .
INTERPRETATION Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities .
BACKGROUND The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established .
However , the extent to which these effects differ by baseline blood pressure , presence of comorbidities , or drug class is less clear .
We therefore performed a systematic review and meta- analysis to clarify these differences .