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 .
Natriuresis and blood pressure reduction in hypertensive patients with diabetes mellitus: the NESTOR study.
The antihypertensive effect of indapamide has never been clearly understood , particularly in hypertensive patients with diabetes mellitus . A total of 565 patients were r and omly selected to receive either indapamide 1.5 mg or enalapril 10 mg daily for 12 months . Brachial blood pressure ( BP ) and plasma and urinary electrolytes were measured at baseline and at the end of follow-up . Sodium and potassium levels and excretion rates were measured in overnight urine collection s. After 12 months ' treatment , similar significant reductions were observed in systolic and diastolic BP and pulse pressure levels in both treatment arms ( P < .001 ) . However , age , body mass index , diabetes duration , and plasma sodium reductions were shown to be major , independent factors influencing BP reduction with indapamide , but not with enalapril . Regression coefficients were positive for age and plasma sodium reductions ( P ≤ .009 ) but negative for body mass index and diabetes duration ( P ≤ .008 ) . Similar findings were observed for pulse pressure . These results were more notable in elderly patients , did not differ regardless of whether BP reduction was measured in absolute or percent values , and were associated with increased sodium and potassium excretion rates . Indapamide is more effective than enalapril at reducing BP in elderly diabetic hypertensives with marked sodium retention
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 .