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 .
Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both.
BACKGROUND Angiotensin-converting-enzyme ( ACE ) inhibitors such as captopril reduce mortality and cardiovascular morbidity among patients with myocardial infa rct ion complicated by left ventricular systolic dysfunction , heart failure , or both . In a double-blind trial , we compared the effect of the angiotensin-receptor blocker valsartan , the ACE inhibitor captopril , and the combination of the two on mortality in this population of patients . METHODS Patients receiving conventional therapy were r and omly assigned , 0.5 to 10 days after acute myocardial infa rct ion , to additional therapy with valsartan ( 4909 patients ) , valsartan plus captopril ( 4885 patients ) , or captopril ( 4909 patients ) . The primary end point was death from any cause . RESULTS During a median follow-up of 24.7 months , 979 patients in the valsartan group  died , as did 941 patients in the valsartan- and -captopril group and 958 patients in the captopril group ( hazard ratio in the valsartan group as compared with the captopril group , 1.00 ; 97.5 percent confidence interval , 0.90 to 1.11 ; P=0.98 ; hazard ratio in the valsartan- and -captopril group as compared with the captopril group , 0.98 ; 97.5 percent confidence interval , 0.89 to 1.09 ; P=0.73 ) . The upper limit of the one-sided 97.5 percent confidence interval for the comparison of the valsartan group with the captopril group was within the prespecified margin for noninferiority with regard to mortality ( P=0.004 ) and with regard to the composite end point of fatal and nonfatal cardiovascular events ( P<0.001 ) . The valsartan- and -captopril group had the most drug-related adverse events . With monotherapy , hypotension and renal dysfunction were more common in the valsartan group , and cough , rash , and taste disturbance were more common in the captopril group . CONCLUSIONS Valsartan is as effective as captopril in patients who are at high risk for cardiovascular events after myocardial infa rct ion . Combining valsartan with captopril increased the rate of adverse events without improving survival
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 .