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 .
One-Year Renal and Cardiac Effects of Bisoprolol versus Losartan in Recently Diagnosed Hypertensive Patients
Abstract Background and objectives : Hypertension is a significant cause of chronic renal injury and its effective treatment is capable of reducing the rate of renal failure . β-Adrenoceptor antagonists ( β-blockers ) have been reported to induce a deterioration in renal function , while several data have indicated a renoprotective effect of treatment with the angiotensin II type 1 receptor antagonist losartan . Previous studies of the interaction between the selective β1-blocker bisoprolol and kidney function were performed only for short- and medium-term periods . The aim of this study was to compare the antihypertensive efficacy and renal and cardiac haemodynamic effects of bisoprolol with those of losartan over a 1-year time period in patients with essential hypertension . Methods : Seventy-two patients ( 40 males ) with recently diagnosed uncomplicated ( European Society of Hypertension [ ESH ] criteria stage 1–2 ) hypertension ( mean ± SD age 52 ± 12 years ) were enrolled in the study . After a run-in period of 14 days on placebo , the patients were r and omized in a double-blind , prospect i ve study to receive either bisoprolol 5 mg or losartan 50 mg , administered once daily for 1 year . At recruitment and 12 months after treatment , cardiac output and renal haemodynamics and function were evaluated by echocardiography and radionuclide studies , respectively . Results : There were no significant differences in baseline clinical data , including glomerular filtration rate and blood pressure , between the two treatment groups . At 1 year , blood pressure had decreased significantly ( p < 0.001 ) with both treatments , and heart rate was reduced only in the group taking bisoprolol . The long-term effects on renal haemodynamics and cardiac function were similar with both drugs , the only change being a significant reduction in the filtration fraction for each group . Conclusions : These data suggest that both bisoprolol and losartan are effective agents for the treatment of patients with recently diagnosed ESH stage 1–2 hypertension . Over a 1-year period , both agents maintained good renal and cardiac performance and haemodynamics
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 .