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 .
Stroke Reduction in Hypertensive Adults With Cardiac Hypertrophy Randomized to Losartan Versus Atenolol: The Losartan Intervention For Endpoint Reduction in Hypertension Study
The Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study showed that treatment with the angiotensin II type-1 receptor antagonist losartan reduces overall stroke risk compared with conventional therapy with the & bgr;-blocker atenolol . We conducted secondary analyses in LIFE to determine the extent to which the cerebrovascular benefits of losartan apply to different clinical subgroups and stroke subtypes and to assess the dependence of these benefits on baseline and time-varying covariates . Among 9193 hypertensive patients with electrocardiographic evidence of left ventricular hypertrophy , r and om allocation to losartan-based treatment lowered the risk of fatal ( hazard ratio [ HR ] , 0.65 ; 95 % confidence interval [ CI ] , 0.43 to 0.96 ; P=0.032 ) and atherothrombotic stroke ( HR , 0.72 ; 95 % CI , 0.59 to 0.88 ; P=0.001 ) compared with atenolol-based therapy . Although comparable risk reductions occurred for hemorrhagic and embolic stroke , these were not statistically significant . The number of neurological deficits per stroke was similar , but there were fewer strokes in the losartan group for nearly every level of stroke severity . Effects were consistent in all clinical subgroups except for those defined by age and ethnicity . The benefits of losartan on all strokes were independent of baseline and time-varying risk factors , including blood pressure . The number needed to treat for 5 years to prevent 1 stroke was 54 for the average participant , declining to 25 , 24 , and 9 for patients with cerebrovascular disease , isolated systolic hypertension , and atrial fibrillation , respectively . In conclusion , substantial cerebrovascular benefit could be realized with the institution of losartan-based therapy over conventional therapy among hypertensive patients with left ventricular hypertrophy across the spectrum of cardiovascular risk
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 .