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 .
The effects of amlodipine and enalapril on renal function in adults with hypertension and nondiabetic nephropathies: a 3-year, randomized, multicenter, double-blind, placebo-controlled study.
BACKGROUND Placebo-controlled trials have found that angiotensin-converting enzyme inhibitors ( ACEIs ) decrease proteinuria and slow the progression of nondiabetic nephropathies . However , head-to-head comparisons of ACEIs and calcium channel blockers ( CCBs ) have shown conflicting results . Indeed , a recent meta analysis concluded that there is still uncertainty about the greater renoprotection seen with ACEIs or angiotensin II receptor blockers in nondiabetic patients with renal disease , particularly when using true glomerular filtration rate ( GFR ) as the primary outcome . OBJECTIVE The objective of this 3-year , r and omized , multicenter , double-blind , placebo-controlled study was to compare true GFR decline ( measured by yearly 51Cr-EDTA blood clearance ) in nondiabetic , nonnephrotic adult hypertensive patients with estimated creatinine clearance of 20 to 60 mL/min.1.73 m(2 ) , when r and omized to a CCB ( amlodipine , 5 - 10 mg/d ) or an ACEI ( enalapril , 5 - 20 mg/d ) . METHODS Patients ( aged 18 - 80 years ) entered a 4-week placebo run-in washout period and previous antihypertensive drugs were tapered off over 2 weeks . Add-on treatments were atenolol ( 50 - 100 mg/d ) , loop diuretics ( furosemide , 20 - 500 mg/d or torsemide , 5 - 200 mg/d ) , alpha-blockers ( prazosin , 2.5 - 5 mg/d or doxazosin , 1 - 16 mg/d ) , and central ly acting drugs ( rilmenidine , 1 - 2 mg/d or methyldopa , 250 - 500 mg/d ) . The primary end point was true GFR measured by yearly (51)Cr-EDTA blood clearance . Secondary end points included a clinical composite of renal events and tolerability collected by a full clinical and laboratory evaluation at each study visit . Post hoc analyses for the change in GFR , proteinuria , and time to clinical events were also planned on baseline proteinuria subgroups ( < 1 and > or=1 g/d ) before unblinding the data base . RESULTS Three hundred eighteen patients entered the run-in period and 263 patients ( 156 men/107 women ; mean age , 58 years ) were r and omized to receive either amlodipine ( 5 mg/d , n=132 ) or enalapril ( 5 mg/d , n=131 ) . Blood pressure declined from 165/102 mm Hg to 138/84 mm Hg and 138/85 mm Hg with amlodipine and enalapril , respectively ( no between-group significance ) . Only 20.8 % of the patients r and omized to ACEI treatment received diuretics at the last observation . No statistically significant difference was found between amlodipine and enalapril in GFR decline ( -4.92 and -3.98 mL/min.1.73 m(2 ) , respectively , at last observation ) and composite secondary end point after a median follow-up of 2.9 years , including in the subgroup of patients with proteinuria > 1 g/d at baseline . Protein excretion rate decreased significantly from baseline in patients taking enalapril plus diuretics ( median -270 mg/d ; P<0.001 ) but not in patients taking amlodipine plus diuretics ( -25 mg/d at last observation ) . CONCLUSION In this cohort of nondiabetic , nonnephrotic hypertensive patients , no statistically significant difference in true GFR decline was found over 3 years between amlodipine-treated patients and enalapril-treated patients with main add-on treatment with ss-blockers , including in the subgroup of patients with proteinuria > 1 g/d
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 .