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 comparison of the effect of ramipril, felodipine and placebo on glomerular filtration rate, albuminuria, blood pressure and vasoactive hormones in chronic glomerulonephritis. A randomized, prospective, double-blind, placebo-controlled study over two years.
The effects of an ACE-inhibitor ( ramipril ) , a calcium antagonist ( felodipine ) and placebo on glomerular filtration rate ( GFR ) , urinary albumin/creatinine ratio , blood pressure ( BP ) and vasoactive hormones were investigated in a r and omized , prospect i ve , double-blind , placebo-controlled study of patients with chronic glomerulonephritis and hypertension , with measurements at entrance and after 12 and 24 months . In total , 33 patients were included : 21 completed the study with 7 patients in each group .  GFR was measured as 51Cr-EDTA clearance and the vasoactive hormones with radioimmunoassays . The reduction in GFR was significantly more pronounced in the felodipine group ( -7 ml/min ) than in the ramipril group ( 0 ml/min ) but the same as in the placebo group ( -6 ml/min ) . The urinary albumin/creatinine ratio was significantly more reduced in the ramipril group ( -74 mg/mmol ) than in the placebo group ( -11 mg/mmol ) , which did not deviate from the felodipine group ( -10 mg/mmol ) . BP was significantly reduced by ramipril and felodipine , but not by placebo .  Angiotensin II and aldosterone in plasma increased or tended to increase in the felodipine and placebo groups , but were unchanged in the ramipril group . Endothelin increased only in the placebo group , and vasopressin , atrial natriuretic peptide , and brain natriuretic peptide were not significantly changed in any of the groups . It is concluded that ramipril seems to be superior to felodipine in chronic glomerulonephritis owing to better preservation of GFR
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 .