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 .
A double-blind comparison of the effects of carvedilol and captopril on serum lipid concentrations in patients with mild to moderate essential hypertension and dyslipidaemia
Summary We have studied 250 patients with mild to moderate essential hypertension ( diastolic blood pressure 95 – 114 mmHg ) and dyslipidaemia ( high-density lipoprotein cholesterol ( HDL-C ) below 1.03 mmol·l−1 , total cholesterol 5.17–9.05 mmol·l−1 , and triglycerides 2.26–5.64 mmol·l−1 ) in a controlled double-blind , multicentre , parallel group trial . The patients took a fat-modified diet . After a 4-week placebo period , patients who continued to fulfil the selection criteria were r and omly allocated to treatment with either carvedilol ( a vasodilating β-blocker ) 25–50 mg o.d . ( n=116 ) or captopril ( an ACE inhibitor ) 25–50 mg o.d . ( n=117 ) for 6 months . In both groups there were favourable effects on the serum lipids . The relative changes ( medians ) in the carvedilol and captopril group were respectively : increase in HDL-C by 11 % and 8 % , decrease in total cholesterol by 11 % and 10 % , in low-density lipoprotein cholesterol by 16 % and 12 % , and in triglycerides by 13 % and 14 % . Equivalence of the two treatments was confirmed for the target variable change in HDL-C at a significance level of 5%.Reductions in supine systolic/diastolic blood pressures were comparable in the two groups ( carvedilol : 23/19 mmHg , captopril : 20/18 mmHg).The improvement in lipid metabolism in patients treated with carvedilol is probably due to its α1-blocking properties
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 .