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 influence of antihypertensive therapy on the structural arteriolar changes in essential hypertension: different effects of enalapril and hydrochlorothiazide.
OBJECTIVES To assess the peripheral and central haemodynamics , in particular the effect on minimal resistance in the h and , with an ACE inhibitor in comparison with a diuretic . DESIGN Double-blind r and omized parallel group study . SUBJECTS Twenty-eight previously untreated men with essential hypertension ( supine diastolic blood pressure > 95 mmHg repeatedly on placebo ) . METHODS /INTERVENTION : Causal and intra-arterial blood pressure , dye-dilution technique , water plethysmography at rest and at ischaemia , enalapril ( n = 14 ) , hydrochlorothiazide ( n = 14 ) . RESULTS After 6 months the mean arterial pressure was reduced from 112.7 to 96.9 mmHg ( change -15.9 mmHg ; 95 % confidence interval ( CI ) -21.9 , -9.8 ) on enalapril and from 110.1 to 101.5 mmHg ( change -8.6 mmHg ; CI -14.4 , -2.8 ) . Heart rate did not change on any of the therapies . Enalapril reduced blood pressure mainly through a reduction in total peripheral resistance ( delta -3.0 PRU100 ; CI -5.6 , -0.4 ) while hydrochlorothiazide reduced blood pressure mainly through a reduction in cardiac output ( delta -0.8 l/min-1 ; CI -1.5 , -0.07 ) . Minimal vascular resistance ( mean of right and left h and ) displayed a significant time x treatment interaction indicating a different trend with enalapril than hydrochlorothiazide with a change of -0.12 PRU100 ( CI -0.33 , 0.05 ) on enalapril and a change of 0.14 ( CI -0.29 , 0.56 ) on hydrochlorothiazide . The resistance level after 6 months was significantly higher on hydrochlorothiazide than on enalapril ( P = 0.0105 ) . CONCLUSION Enalapril reduced blood pressure through vasodilatation and hydrochlorothiazide through decreased cardiac output . The two therapies also affected minimal vascular resistance ( an indirect measure of vascular wall thickness ) differently ; with enalapril showing a favourable response in contrast to hydrochlorothiazide
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 .