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 Treatment With Candesartan or Enalapril on Subcutaneous Small Artery Structure in Hypertensive Patients With Noninsulin-Dependent Diabetes Mellitus
Structural alterations of subcutaneous small resistance arteries are associated with a worse clinical prognosis in hypertension and noninsulin-dependent diabetes mellitus ( NIDDM ) . However , no data are presently available about the effects of antihypertensive therapy on vascular structure in hypertensive patients with NIDDM . Therefore , we have investigated the effect of an angiotensin-converting enzyme inhibitor , enalapril , and a highly selective angiotensin receptor blocker , c and esartan cilexetil , on indices of subcutaneous small resistance artery structure in 15 patients with mild hypertension and NIDDM . Eight patients were treated with c and esartan ( 8 to 16 mg per day ) and 7 with enalapril ( 10 to 20 mg per day ) for 1 year . Each patient underwent a biopsy of the subcutaneous fat from the gluteal region at baseline and after 1 year of treatment . Small arteries were dissected and mounted on a micromyograph and the media-to-internal lumen ratio was evaluated ; moreover , endothelium-dependent vasodilation to acetylcholine was assessed . A similar blood pressure-lowering effect and a similar reduction of the media-to-lumen ratio of small arteries was observed with the 2 drugs . Vascular collagen content was reduced and metalloproteinase-9 was increased by c and esartan , but not by enalapril . Changes of circulating indices of collagen turnover and circulating matrix metalloproteinase paralleled those of vascular collagen . The 2 drugs equally improved endothelial function . In conclusion , antihypertensive treatment with drugs that inhibit the renin-angiotensin-aldosterone system activity is able to correct , at least in part , alterations in small resistance artery structure in hypertensive patients with NIDDM .  C and esartan may be more effective than enalapril in reducing collagen content in the vasculature
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 .