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 .
Greater regression of electrocardiographic left ventricular hypertrophy during hydrochlorothiazide therapy in hypertensive patients.
BACKGROUND Treatment of hypertensive patients with a losartan-based regimen  was associated with greater regression of electrocardiographic ( ECG ) left ventricular hypertrophy ( LVH ) than atenolol-based therapy in the Losartan Intervention for Endpoint Reduction in Hypertension ( LIFE ) study , independent of blood pressure ( BP ) changes . However , whether concomitant hydrochlorothiazide ( HCTZ ) therapy in > 70 % of LIFE patients was associated with greater regression of LVH independent of BP changes and whether this effect differed between treatment arms has not been examined . METHODS Changes in Cornell product and Sokolow-Lyon voltage LVH were assessed in 9,193 hypertensive patients r and omly assigned to treatment with losartan or atenolol  , with additional HCTZ therapy added as necessary to achieve target BP goal per study protocol . RESULTS After controlling for baseline and change in systolic and diastolic pressure , age , sex , race , prior antihypertensive treatment , baseline and year-4 body mass index and baseline LVH by either Cornell product or Sokolow-Lyon voltage , at year-4 follow-up HCTZ therapy was associated with greater regression of Cornell product LVH ( -244 + /- 788 vs. -172 + /- 771 mm.msec , P < 0.05 ) and Sokolow-Lyon voltage ( -4.2 + /- 6.7 vs. -3.0 + /- 7.0 mm , P < 0.001 ) and this effect was significantly greater in patients on losartan ( -341 + /- 743 vs. -189 + /- 775 mm.msec and -5.2 + /- 6.6 vs. -3.3 + /- 6.6 mm ) than in patients on atenolol ( -142 + /- 822 vs. -158 + /- 765 mm.msec and -3.1 + /- 6.6 vs. -2.7 + /- 7.4 mm ; both P < 0.001 for interaction of HCTZ with losartan vs. atenolol therapy ) . CONCLUSIONS HCTZ use was associated with greater regression of ECG LVH and this effect was greater in patients on losartan- than atenolol-based therapy , independent of baseline severity of ECG LVH and hypertension and changes in BP
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 .