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Table 29GRADE balance sheet

OutcomeNumber of patients treated with ACEIs, ARBs, or direct renin inhibitors and assessed for outcome of interestEffect based on meta-analysisQualityRelative importance
ACEIARBDirect renin inhibitorEffect (95% CI)
BP reduction~ 13,600~ 13,6001104-HighCritical
Rate of use of a single antihypertensive for BP control~12,840~12,840No dataEstimated odds ratio of ARBs vs. ACEIs 1.083 (95% CI 0.937 to 1.252)High
Mortality and major CV events~18,700~18,7001104-ModerateCritical
Morbidity/Quality of life~ 550~ 550No difference detectedLow-
Cough45,44122,437877Estimated odds ratio of ARBs vs. ACEIs 0.212 210 (95% CI 0.158 to 0.279)High
Estimated odds ratio of direct renin inhibitors vs. ACEIs 0.333 (95% CI 0.2241 to 0.4933)Low
Adverse events – withdrawals47444935877Estimated odds ratio of ARBs vs. ACEIs 0.565 (95% CI 0.453 to 0.704)

Estimated odds ratio of direct renin inhibitors vs. ACEIs 0.886 (95% CI 0.458 to 1.714)
HighCritical
Persistence/ adherence158,571157,706877-Moderate
Lipid levels51125278No data-Moderate-
Progression to type 2 diabetesNo dataNo dataNo data-Low-
Markers of carbohydrate metabolism/diabetes control50425191No data-Moderate-
Measures of LV mass/function~777~545~233-Low-
Measures of kidney disease – creatinine/GFR1004483457Serum creatinine:
Standardized mean difference of ARBs vs. ACEIs 0.109 (95% CI -0.054 to 0.272)

Creatinine clearance:
Standardized mean difference of ARBs vs. ACEIs -0.217 (95% CI -0.515 to 0.080)

GFR:
Standardized mean difference of ARBs vs. ACEIs -0.227 (95% CI -0.486 to 0.032)

All flow studies:
Standardized mean difference of ARBs vs. ACEIs -0.227 (95% CI -0.396 to -0.028)
Moderate-
Measures of kidney disease – proteinuria33424273-Low-

BP = blood pressure; CI = confidence interval; CV = cardiovascular; GFR = glomerular filtration rate; LV = left ventricular; - = no relevant data

From: Summary and Discussion

Cover of Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), and Direct Renin Inhibitors for Treating Essential Hypertension: An Update
Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), and Direct Renin Inhibitors for Treating Essential Hypertension: An Update [Internet].
Comparative Effectiveness Reviews, No. 34.
Sanders GD, Coeytaux R, Dolor RJ, et al.

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