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 .
CORD: COmparsion of Recommended Doses of ACE inhibitors and angiotensin II receptor blockers.
OBJECTIVES The CORD trials tested ramipril and losartan in patients with hypertension . PATIENTS AND METHODS CORD IA involving switching from an angiotensin-converting enzyme inhibitor ( ACEI ) to the angiotensin II receptor blocker ( ARB ) losartan .  4,016 patients with blood pressure ( BP ) < 160/100 mm Hg who had been treated with an ACEI for > 3 months were enrolled . The mean age was 62.6 + /- 11.6 years and 53.1 % were women . The patients discontinued ACEI and switched to losartan 50 mg once daily .  BP , heart rate , biochemistry , blood counts and ECGs were measured at day 1 and months 1 , 3 , 6 and 12 . If the BP was > or = 140/90 mm Hg after 1 month or more , the dose of losartan was increased to 100 mg . After 1 month the BP decreased from 147.4 + /- 14.8/87.7 + /- 9.3 mm Hg to 139.7 + /- 11.8/83.0 + /- 9.3 mm Hg ( p < 0.001 ) and after 1 year to 133.7 + /- 11.3/79.1 + /- 7.06 mm Hg ( p < 0.001 ) . The rate of adverse events did not significantly increase and no changes in plasma sodium , potassium , urea or creatinine were observed . CORD IB compared ramipril and losartan . 3,813 patients with BP > or = 140/90 mm Hg who were not being treated with an ACEI or ARB were enrolled . The mean age was 60.5 + /- 12.2 years and 50.5 % were women . The patients were r and omised to ramipril 5 mg ( n = 1,926 ) or losartan 50 mg ( n = 1,887 ) . The dose was doubled if BP after 1 month was > or = 140/90 mm Hg . If the BP after 3 months still was > or = 140/90 mm Hg , another antihypertensive drug was added , typically athiazide diuretic . RESULTS After 1 yearthe BP decreased in the ramipril group from 155.9 + /- 13.1/93.0 + /- 8.9 mm Hg to 134.1 + /- 11.2/81.5 + /- 6.8 mm Hg ( p < 0.001 ) and in the losartan group from 156.5 + /- 13.1/93.4 + /- 8.8 to 134.55 + /- 11.3/80.16 + /- 6.6 mm Hg ( p < 0.001 ) . No significant differences were found between the groups . A slight increase in plasma potassium ( 0.2 mmol in both groups ) and urea ( 0.3 mmol in both groups ) was observed , but no change in plasma creatinine . There was a small , insignificant decrease in plasma uric acid ( in the ramipril group from 325.5 to 320.7 micromol/l and in the losartan group from 321.6 to 318.3 micromol/l ) and a slight decrease in plasma glucose and triglycerides ( 0.2 mmol/l in both measures in both groups ) . No severe adverse events were observed , but dry cough was 8 times more frequently reported in the ramipril group . CONCLUSION CORD IA confirmed that switching from an ACEI to losartan is safe and effective . Titrating the dose upwards or adding diuretics leads to good BP control in the majority of patients ( 2/3 ) . CORD IB showed no differences between ramipril and losartan in lowering BP and both drugs showed a trend to improve metabolic parameters such as glycaemia , triglyceridaemia and uric acid equally . Dry cough was more frequent after ACEI
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 .