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 .
Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study.
OBJECTIVES We report on a sub analysis of the effects of losartan and atenolol on cardiovascular events in black patients in the Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study . BACKGROUND The LIFE study compared losartan-based to atenolol-based therapy in 9,193 hypertensive patients with left ventricular hypertrophy ( LVH ) . Overall , the risk of the primary composite end point ( cardiovascular death , stroke , myocardial infa rct ion ) was reduced by 13 % ( p = 0.021 ) with losartan , with similar blood pressure ( BP ) reduction in both treatment groups . There was a suggestion of interaction between ethnic background and treatment ( p = 0.057 ) . METHODS Exploratory analyses were performed that placed LIFE study patients into black ( n = 533 ) and non-black ( n = 8,660 ) categories , overall , and in the U.S. ( African American [ n = 523 ] ; non-black [ n = 1,184 ] ) . RESULTS A significant interaction existed between the dichotomized groups ( black/non-black ) and treatment ( p = 0.005 ) ; a test for qualitative interaction was also significant ( p = 0.016 ) . The hazard ratio  ( losartan relative to atenolol ) for the primary end point favored atenolol in black patients ( 1.666 [ 95 % confidence interval ( CI ) 1.043 to 2.661 ] ; p = 0.033 ) and favored losartan in non-blacks ( 0.829 [ 95 % CI 0.733 to 0.938 ] ; p = 0.003 ) . In black patients , BP reduction was similar in both groups , and regression of electrocardiographic-LVH was greater with losartan . CONCLUSIONS Results of the sub analysis are sufficient to generate the hypothesis that black patients with hypertension and LVH might not respond as favorably to losartan-based treatment as non-black patients with respect to cardiovascular outcomes , and do not support a recommendation for losartan as a first-line treatment for this purpose . The sub analysis is limited by the relatively small number of events
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 .