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 .
Baseline characteristics of the diabetic participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
OBJECTIVE  Hypertension ( HTN ) is a major risk factor for cardiovascular disease ( CVD ) in the setting of diabetes . There is no consensus on how best to treat hypertension among those with diabetes . Here we describe the characteristics of a cohort of hypertensive adults with diabetes who are part of a large prospect i ve blood pressure study . This study will help clarify the treatment of HTN in the setting of diabetes . RESEARCH DESIGN AND METHODS The Antihypertensive and Lipid-Lowering high-risk hypertensive participants , ages > or = 55 years , design ed to determine whether the incidence of fatal and nonfatal coronary heart disease ( CHD ) and combined cardiovascular events ( fatal and nonfatal CHD , revascularization surgery , angina pectoris , congestive heart failure , and stroke ) differs between diuretic ( chlorthalidone ) treatment and three alternative antihypertensive therapies : a calcium channel blocker ( amlodipine ) , an ACE inhibitor ( lisinopril ) , and an alpha-adrenergic blocker ( doxazosin ) . The planned follow-up is an average of 6 years , to be completed March 2002 . RESULTS There are 15,297 diabetic individuals in the ALLHAT study ( 36.0 % of the entire cohort ) . Of these individuals , 50.2 % are male , 39.4 % are African-American , and 17.7 % are Hispanic . Demographic and laboratory characteristics of the cohort are similar to those of other studies of the U.S. elderly population with HTN . The sample size has 42 and 93 % confidence , treatments for the two study outcomes . CONCLUSIONS The diabetic cohort in ALLHAT wil be able to provide valuable information about the treatment of hypertension in older diabetic patients at risk for incident CVD
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 .