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 nisoldipine and lisinopril on left ventricular mass and function in diabetic nephropathy.
OBJECTIVE To compare the effects of the calcium channel blocker , nisoldipine , and the ACE inhibitor , lisinopril , on left ventricular mass ( LVM ) and systolic function in type 1 diabetic patients with diabetic nephropathy . RESEARCH DESIGN AND METHODS M-mode echocardiography was performed in 50 hypertensive type 1 diabetic patients with diabetic nephropathy enrolled in a 1-year , r and omized , double-blind , parallel study of antihypertensive treatment with nisoldipine CC ( 20 - 40 mg/day ) or lisinopril ( 10 - 20 mg/day ) . Ambulatory 24-h blood pressure was measured with the Takeda TM 2420 device ( A & D , Tokyo , Japan ) every 3 months . Three patients dropped out and seven patients were excluded due to technical difficulties . RESULTS The 24-h diastolic blood pressure was reduced from 83 to 80 mmHg in the nisoldipine group ( P = 0.06 ) and from 85 to 80 mmHg in the lisinopril group ( P = 0.02 ) . The decline in systolic blood pressure was not significant with any of the two treatments , and no difference in reduction of blood pressure was seen between groups . LVM corrected for body surface area ( LVMI ) was comparable between groups at baseline and increased from 96 + /- 5 to 107 + /- 6 g/m2 ( mean + /- SEM ; P = 0.007 ) in the nisoldipine group and from 95 + /- 4 to 103 + /- 5 g/m2 ( P = 0.03 ) in the lisinopril group . The mean difference between the change in LVMI in the two groups was 2.9 ( 95 % CI 6.8 to 12.7 ) g/m2 . The prevalence of left ventricular hypertrophy rose from 18 ( 95 % CI 6 - 30 ) to 30 % ( 16 - 44 ) during the study period . A multiple linear regression analysis revealed that after 1 year of treatment , LVMI increased with higher systolic blood pressure level and declining glomerular filtration rate ( R2 = 0.25 ) . Fractional shortening was within normal range at baseline , 42 + /- 1 vs. 41 + /- 1 % with nisoldipine and lisinopril , respectively , and did not change during follow-up . CONCLUSIONS Antihypertensive treatment with nisoldipine or lisinopril to bring diastolic blood pressure level within the normal target range does not hinder a rise in LVMI in type 1 diabetic patients with diabetic nephropathy
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 .