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 .
Myocardial Perfusion During Long-Term Angiotensin-Converting Enzyme Inhibition or &bgr;-Blockade in Patients With Essential Hypertension
Hypertension is associated with reduced coronary vasodilatory capacity , possibly caused by structural changes in the coronary resistance vessels . Because vasodilatory treatment may correct abnormal structure better than nonvasodilating treatment , we compared whether long-term angiotensin-converting enzyme ( ACE ) inhibition has a greater effect on coronary reserve and cardiovascular structure than & bgr;-blockade in patients with essential hypertension . Thirty previously untreated hypertensive patients were r and omized in a double-blind design to treatment for 1 year with either perindopril ( 4 to 8 mg per day , n=15 ) or atenolol ( 50 to 100 mg per day , n=15 ) and furthermore compared with normotensive controls . Cardiac output and left ventricular mass were measured with echocardiography and resistance artery structure was determined in vitro . Using positron emission tomography , myocardial perfusion ( MP ) was determined at rest and during dipyridamole-induced hyperemia while still on medication . Perindopril  reduced left ventricular mass by 14±4 % ( P<0.01 ) , peripheral vascular resistance by 12±6 % ( P<0.01 ) , and media thickness-to-lumen diameter ratio of resistance arteries by 16±4 % ( P<0.05 ) , whereas atenolol had no effect . Resting MP was decreased both by perindopril ( −11±4 % , P<0.01 ) and by atenolol ( −25±4 % , P<0.01 ) in parallel to the reduction in rate pressure product . Hyperemic MP was unaltered by perindopril ( + 2±6 % , P = NS ) , but reduced by atenolol ( −32±5 % , P<0.01 ) . Compared with atenolol , perindopril treatment result ed in higher coronary reserve ( P<0.05 ) . We conclude that compared with & bgr;-blockade , ACE inhibition increases coronary reserve and results in regression of hypertensive resistance artery structure and left ventricular hypertrophy . Vasodilating may thus be superior to nonvasodilating treatment in repairing the hypertensive myocardial microcirculation
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 .