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 .
Comparison of effects of quinapril and metoprolol on glycaemic control, serum lipids, blood pressure, albuminuria and quality of life in non-insulin-dependent diabetes mellitus patients with hypertension. Swedish Quinapril Group.
OBJECTIVE To compare the long-term effects of the angiotensin-converting enzyme (ACE)-inhibitor quinapril and the cardioselective beta-adrenergic blocking agent metoprolol on glycaemic control , with glycosylated haemoglobin ( HbA1c ) as the principal variable , in non-insulin-dependent diabetes mellitus ( NIDDM ) patients with hypertension . DESIGN A r and omized , double-blind , double-dummy , multicentre study during 6 months preceded by a 4 week wash-out and a 3 week run-in placebo period . Quinapril ( 20 mg ) and metoprolol ( 100 mg , conventional tablets ) were given once daily . No change was made in the treatment of diabetes ( diet and hypoglycaemic agents ) . SUBJECTS Seventy-two patients fulfilling the criteria were r and omized and entered the double-blind period . Twelve patients did not complete the study . Sixty patients , 26 on quinapril and 34 on metoprolol , were available for the final analysis . MAIN OUTCOME MEASURES The effect was assessed by changes in HbA1c , the fasting serum glucose and the post-load serum glucose , C-peptide and insulin levels during the oral glucose tolerance test . RESULTS In the quinapril group , the fasting serum glucose , oral glucose tolerance and the C-peptide and insulin responses , determined as the incremental area under the curves ( AUC ) , showed no change , but the mean HbA1c level increased from 6.2 + /- 1.1 % to 6.5 + /- 1.3 % ( P < 0.05 ) . In the metoprolol group , the rise in the mean level of HbA1c , from 6.3 + /- 1.0 % to 6.8 + /- 1.3 % ( P < 0.01 ) , tended to be more marked than after quinapril , although there was no significant difference between the increments . The mean fasting serum glucose showed an increase from 9.1 + /- 1.9 mM to 10.1 + /- 2.8 mM ( P < 0.01 ) which correlated significantly with the duration of diabetes ( P < 0.01 ) and the increase in fasting serum triglycerides ( P < 0.001 ) . Moreover , in the metoprolol group we found significant decreases in the oral glucose tolerance as well as C-peptide and insulin responses to the glucose load . CONCLUSIONS Treatment with quinapril for 6 months appears to have advantages over metoprolol in NIDDM patients with hypertension . Although treatment with quinapril  or  metoprolol over 6 months was concomitant with a rise in the HbA1c , increased fasting blood glucose , decreased oral glucose tolerance and decreased C-peptide and insulin responses to a glucose challenge were observed only in patients treated with metoprolol
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 .