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 .
Effects of losartan compared with atenolol on lipids in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention For Endpoint reduction in hypertension study
Objective Beta-blockers and angiotensin II receptor blockers have different effects on lipids . Methods We examined lipid levels in the Losartan Intervention For Endpoint reduction in hypertension study and their impact on the primary composite endpoint of cardiovascular death , myocardial infa rct ion , or stroke . We measured total and high-density lipoprotein cholesterol at baseline and annually during 4.8 years of losartan-based compared with atenolol-based treatment in 8611 patients with hypertension and left ventricular hypertrophy . Results Patients r and omized to  losartan-based or atenolol-based treatment had similar baseline total ( 6.04 ± 1.12 vs. 6.05 ± 1.13 mmol/l , NS ) and high-density lipoprotein ( HDL ) cholesterol ( 1.50 ± 0.44 vs. 1.49 ± 0.44 mmol/l , NS ) . Total cholesterol decreased significantly but equally ( −0.37 ± 1.05 vs. −0.34 ± 1.09 mmol/l , NS ) , whereas HDL cholesterol decreased less during the first 2 years in patients r and omized to losartan compared with atenolol ( −0.13 ± 0.24 vs. −0.19 ± 0.25 mmol/l ) and remained higher each year ( 1.38 , 1.37 , 1.42 , 1.47 , and 1.48 mmol/l vs. 1.32 , 1.30 , 1.36 , 1.40 , and 1.42 mmol/l , all P < 0.001 ) independent of hydrochlorothiazide or statin treatment . In Cox regression analysis , baseline total cholesterol [ hazard ratio ( HR ) = 1.08 ( 1.02–1.14 ) per mmol/l , P < 0.01 ] , HDL cholesterol [ HR = 0.56 ( 0.48–0.66 ) per mmol/l , P < 0.001 ] , and treatment allocation [ HR = 0.86 ( 0.76–0.98 ) , P < 0.05 ] predicted composite endpoint independently . Using time-varying analyses , the predictive strength of HDL cholesterol was increased [ HR = 0.36 ( 0.30–0.44 ) per mmol/l , P < 0.001 ] , whereas that of total cholesterol [ HR = 1.03 ( 0.97–1.09 ) per mmol/l , NS ] and treatment allocation [ HR = 0.91 ( 0.80–1.03 ) , NS ] were reduced . Conclusion Losartan blunted the decrease in HDL cholesterol during antihypertensive treatment in the LIFE study . Higher intreatment HDL cholesterol was associated with fewer composite endpoints and may partly explain the better outcome of losartan-based treatment
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 .