Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .
Effect of valsartan and ramipril on atrial fibrillation recurrence and P-wave dispersion in hypertensive patients with recurrent symptomatic lone atrial fibrillation.
BACKGROUND This study compared the effect of antihypertensive treatment with valsartan or ramipril on  atrial fibrillation ( AF ) recurrence  , on P-wave dispersion , ( PWD ) and on serum procollagen type I carboxy terminal peptide ( PIP ) . METHODS A total of 369 mild hypertensive ( systolic blood pressure ( SBP ) > 140 and /or 90 < diastolic blood pressure ( DBP ) < 110 mm Hg ) out patients in sinus rhythm but with at least two episodes of AF in the previous 6 months were r and omized to valsartan ( n = 122 ) , ramipril  ( n = 124 ) , or amlodipine  ( n = 123 ) for 1 year . Clinic blood pressure ( BP ) and a 24-h electrocardiogram ( ECG )  were evaluated monthly . Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible . PWD and serum PIP levels were evaluated before and after each treatment period . RESULTS SBP and DBP were significantly reduced by the three treatments ( P < 0.001 ) . A total of 46 ( 47.4 % ) patients treated with amlodipine had a recurrence of AF as did 26 ( 27.9 % ) patients treated with ramipril ( P < 0.01 vs. amlodipine ) and 16 ( 16.1 % ) patients treated with valsartan ( P < 0.01 vs. amlodipine and P < 0.05 vs. ramipril ) . The Kaplan-Meyer analysis showed a significant reduction of AF episodes in the valsartan group ( P = 0.005 log-rank test ) as well as in the ramipril group ( P = 0.021 ) , even if at a lesser degree . PWD values were significantly reduced by ramipril ( -4.2 ms , P < 0.05 ) and even more by valsartan ( -11.2 ms , P < 0.01 ) , the difference being significant ( P < 0.01 ) . Serum PIP levels were reduced by ramipril ( -49.7 microg , P < 0.001 ) and valsartan ( -49.3 microg , P < 0.001 ) . CONCLUSIONS Despite similar BP lowering , valsartan and ramipril were more effective than amlodipine in preventing new episodes of AF , but the effect of valsartan was greater than that of ramipril . This could be related to the greater PWD reduction observed with valsartan
Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .