Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .
Aggressive antihypertensive therapy based on hydrochlorothiazide, candesartan or lisinopril as initial choice in hypertensive type II diabetic individuals: effects on albumin excretion, endothelial function and inflammation in a double-blind, randomized clinical trial
We investigated the effects of aggressive antihypertensive therapy based on hydrochlorothiazide , c and esartan or lisinopril on urinary albumin excretion , endothelial function and inflammatory activity in hypertensive type II diabetic individuals . A total of 70 hypertensive type II diabetic individuals were treated with three antihypertensive strategies in a r and omized , double-blind , double-dummy design . Blood pressure was titrated to levels below 130/85 mmHg or a decrease in systolic pressure of 10 % with a diastolic pressure below 85 mmHg . After titration , patients were treated for 12 months . Mean blood pressures changed from 157/93 , 151/94 and 149/93 at baseline to 135/80 , 135/82 and 131/80 mmHg after titration in the hydrochlorothiazide ( n=24 ) , c and esartan ( n=24 ) and lisinopril ( n=22 ) groups . About 70 % reached target blood pressures . However , only 45 % had blood pressures < 130/85 mmHg . Urinary albumin excretion and levels of soluble vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 decreased ( GEE regression coefficients , −2.40 mg/24 h ( P<0.001 ) , −85 ng/ml ( P=0.01 ) and −50 ng/ml ( P=0.02 ) ) , but brachial artery endothelium-dependent and -independent vasodilation and levels of von Willebr and factor and C-reactive protein did not change ( GEE regression coefficients , 0.21 mm ( P=0.07 ) , 0.04 mm ( P=0.43 ) , 0.04 IU/ml ( P=0.33 ) and −1.15 mg/l ( P=0.64 ) ) . No differences in outcome variables between treatment groups were observed . These data show that achievement of target blood pressures below 130/85 mmHg in hypertensive type II diabetes is difficult . Aggressive antihypertensive therapy can improve urinary albumin excretion , endothelial function and inflammatory activity in hypertensive type II diabetic individuals , regardless of the type of antihypertensive therapy used
Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
BACKGROUND Angiotensin converting enzyme inhibitors ( ACE inhibitors ) and angiotensin receptor blockers ( ARBs ) are widely prescribed for primary hypertension ( systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg ) .
However , while ACE inhibitors have been shown to reduce mortality and morbidity in placebo-controlled trials , ARBs have not .
Therefore , a comparison of the efficacies of these two drug classes in primary hypertension for preventing total mortality and cardiovascular events is important .
OBJECTIVES To compare the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events , and their rates of withdrawals due to adverse effects ( WDAEs ) , in people with primary hypertension .