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 .
Comparison of actions of irbesartan versus atenolol on cardiac repolarization in hypertensive left ventricular hypertrophy: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation Versus Atenolol (SILVHIA).
Left ventricular ( LV ) hypertrophy is associated with a substantial risk for malignant arrhythmias and sudden death . The effects of antihypertensive therapy on QT dispersion , which reflects cardiac repolarization heterogeneity , in relation to changes in LV mass has not been well studied . Repeat echocardiography and QT measurements ( st and ard 12-lead electrocardiograms ) were performed in hypertensive patients with LV hypertrophy , who were r and omized double-blind to receive the angiotensin II type 1-receptor blocker irbesartan ( n = 44 ) or the beta(1)-receptor blocker atenolol ( n = 48 ) for 48 weeks , and in 37 matched hypertensive control subjects without LV hypertrophy .  LV mass index was related to QT dispersion ( r = 0.34 , p < 0.001 ) . The reduction in LV mass was greater using irbesartan than using atenolol ( -27 + /- 28 vs -15 + /- 21 g/m(2 ) at 48 weeks , p = 0.021 ) , with similar reductions in blood pressure . Irbesartan decreased QT dispersion ( from 56 + /- 24 ms to 45 + /- 20 ms at 48 weeks ; p < 0.001 ) and QTc dispersion ( from 57 + /- 24 to 44 + /- 19 ms at 48 weeks ; p < 0.001 ) . In contrast , atenolol had minor effects . The decreases in QT and QTc dispersions were greater using irbesartan than using atenolol ( p = 0.001 and p = 0.011 , respectively ) ; the same results were found when changes in LV mass , blood pressure , and heart rate were also included in multivariate analyses . Thus , heterogeneity of ventricular repolarization is related to the degree of LV hypertrophy . Irbesartan , but not atenolol , reduces QT and QTc dispersions independent of changes in LV mass , blood pressure , or heart rate , and thus seems to induce structural and electrical remodeling in a direction that could decrease the risk of fatal events in hypertensive patients
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 .