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 .
Effect of Irbesartan Versus Atenolol on Left Ventricular Mass and Voltage: Results of the CardioVascular Irbesartan Project
Regression of hypertensive left ventricular hypertrophy ( LVH ) is associated with improved prognosis . The aim of this trial was to compare the effects of irbesartan versus atenolol on LVH in subjects with essential hypertension . Because electrocardiographic and echocardiographic parameters of LVH carry disparate prognostic information , both methods were applied in this trial . In the r and omized , double-blind , multicenter trial CardioVascular Irbesartan Project , 240 patients with essential hypertension were treated with irbesartan or atenolol for 18 months . Voltage criteria used for LVH were Sokolow index , Cornell index , Cornell voltage × QRS duration product and Lewis index . In parallel , left ventricular mass ( LVM ) was determined by 2-dimensional guided M-mode echocardiography . After 6 and 18 months , reductions of LVM and voltage criteria for LVH were only found in subjects treated with irbesartan . However , a reduction of LVM was only detectable in subjects within the highest quartile of baseline LVM but not overall . In contrast , reductions of voltage criteria for LVH were detectable after 6 and 18 months even within commonly used normal limits . In conclusion , treatment of hypertension with irbesartan result ed in a significant reduction in the voltage criteria for LVH , although an effect on LVM was only seen in subjects with high baseline LVM . In contrast , atenolol did not lead to reductions in electrocardiographic or echocardiographic parameters of LVH . Because voltage criteria for LVH have been shown to predict cardiovascular outcome independently from LVM , we suggest that both methods should be used to accurately assess the benefits of antihypertensive treatment
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 .