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Antihypertensive effects and safety of eprosartan: a meta-analysis of randomized controlled trials

This review found eprosartan was as effective as many first-line anti-hypertensive medications for essential hypertension, particularly for systolic hypertension alone. The review was generally well conducted and the authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Drug Class Review: Direct Renin Inhibitors, Angiotensin Converting Enzyme Inhibitors, and Angiotensin II Receptor Blockers: Final Report [Internet]

The renin-angiotensin system is a complex biologic system between the heart, brain, blood vessels, and kidneys that leads to the production of biologically active agents, including angiotensin I and II and aldosterone, which act together to impact a variety of bodily functions including blood vessel tone, sodium balance, and glomerular filtration pressure. The multiple and varied effects of these agents allows the renin-angiotensin system to play a wide role in the pathology of hypertension, cardiovascular health, and renal function. Our ability to begin to intervene upon the complex cycle of hormone and other biochemical agent production within the renin-angiotensin system began with the advent of the first orally active ACE-I (angiotensin converting enzyme inhibitor), captopril, in 1981. AIIRAs (angiotensin II receptor blockers) were developed as an alternative to ACE-I, and block the interaction between angiotensin II and the angiotensin receptor. Losartan, the first commercially available AIIRA, was approved for clinical use in 1995. The goal of this report is to compare the effectiveness and harms between aliskiren and placebo and between AIIRAs and ACEIs in the treatment of diagnosed coronary heart disease, hypertension, left ventricular dysfunction, heart failure, nondiabetic chronic kidney disease, or diabetic nephropathy.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2010
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), and Direct Renin Inhibitors for Treating Essential Hypertension: An Update [Internet]

A 2007 comparative effectiveness review (CER) evaluated the long-term benefits and harms of angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin II receptor blockers/antagonists (ARBs) for treating essential hypertension in adults. Since then, significant additional research has been published comparing these agents, and direct renin inhibitors (DRIs) have been introduced to the market. We sought to update 2007 CER on ACEIs versus ARBs and expand this to include comparisons with DRIs.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: June 2011
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Angiotensin receptor blockers for the treatment of high blood pressure

A class of drugs called angiotensin receptor blockers (ARBs) is commonly used to lower high blood pressure. This class includes drugs such as losartan (brand name: Cozaar), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis) and valsartan (Diovan). We asked how much this class of drugs lowers blood pressure and whether there is a difference between individual drugs within the class. The available scientific literature was searched to find all trials that had assessed these questions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Are angiotensin receptor blockers (ARBs) an effective treatment for heart failure?

Drugs called angiotensin receptor blockers (ARBs), such as losartan (brand name: Cozaar), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis) and valsartan (Diovan) are commonly used to treat heart failure. We asked whether ARBs reduced death, or severe disability as assessed by hospital admission for any reason versus an inert substance (placebo) or another class of drugs called ACE inhibitors, such as ramipril (Altace), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), and quinapril (Accupril). We also asked whether combining an ARB with an ACE inhibitor is more effective than an ACE inhibitor alone in reducing death, disability, or hospital admission for any reason. The scientific literature was searched to find all trials that had assessed these questions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Different antihypertensive drugs as first line therapy in patients with essential hypertension: Executive summary of final report A05-09, Version 1.0

The aim of this investigation is to find out the extent to which the benefit of antihypertensive drugs is dependent on the choice of the first-line drug in the treatment of essential hypertension.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 15, 2009

Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34 [Internet]

NICE first issued guidance for the management of hypertension in primary care in 2004. This was followed by a rapid update of the pharmacological treatment chapter of the guideline in 2006. The current partial update of the hypertension guideline is in response to the regular five year review cycle of existing NICE guidance. It began with a scoping exercise which identified key areas of the existing guideline for which new evidence had emerged that was likely to influence or change existing guideline recommendations.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2011
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Comparative Effectiveness of Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease [Internet]

This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) concerning the benefits and harms associated with using angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), either alone or in combination, in people with stable ischemic heart disease or ischemic heart disease risk equivalents and intact left ventricular systolic function.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: October 2009
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Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet]

A substantial proportion of patients with cardiovascular diseases use dietary supplements in anticipation of benefit. This also poses risks of adverse events from supplement-drug interactions and nonadherence associated with polypharmacy.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2012
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Stable Angina: Methods, Evidence & Guidance [Internet]

Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress. It is the main symptomatic manifestation of myocardial ischaemia and is usually caused by obstructive coronary artery disease restricting oxygen delivery to the cardiac myocytes. Other factors may exacerbate angina either by further restricting oxygen delivery (for example severe anaemia) or by increasing oxygen demand (for example left ventricular hypertrophy). Angina symptoms are associated with other cardiac disease such as aortic stenosis but the management of angina associated with non-coronary artery disease is outside the scope of this guideline.

NICE Clinical Guidelines - National Clinical Guidelines Centre (UK).

Version: July 2011
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Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update [Internet]

This guideline is a partial update of NICE Guideline No 5: Chronic Heart Failure - national clinical guideline for diagnosis and management in primary and secondary care (2003). The aim of the 2003 guideline was to offer best practice advice on the care of adult patients (aged 18 years or older) who have symptoms or a diagnosis of chronic heart failure. It defined the most effective combination of symptoms, signs and investigations required to establish a diagnosis of heart failure, and those which would influence therapy or provide important prognostic information. It also gave guidance on the treatment, monitoring and support of patients with heart failure.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2010
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Acute Kidney Injury: Prevention, Detection and Management Up to the Point of Renal Replacement Therapy [Internet]

Acute kidney injury (AKI), previously called acute renal failure, has chiefly been described as a syndrome since World War 2. Traditionally ‘acute renal failure’ was regarded as a less common organ failure, with patients typically requiring dialysis and managed by nephrologists. This view has now been overturned. AKI encompasses a wide spectrum of injury to the kidneys, not just ‘kidney failure’. It is a common problem amongst hospitalised patients, in particular the elderly population whose numbers are increasing as people live longer. Such patients are usually under the care of doctors practicing in specialties other than nephrology. For normal function the kidneys require a competent circulation. Conversely, it is known that renal function is vulnerable to even relative or quite modest hypotension or hypovolaemia. Hence AKI is a feature of many severe illnesses. Although these illnesses may affect many organs, the simple process of monitoring urine output and/or creatinine permits detection of AKI.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2013
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Eplerenone (Inspra) (25 mg Tablet and 50 mg Tablet): As an Adjunct to Standard Therapy to Reduce the Risk of Cardiovascular Mortality and Hospitalization for Heart Failure in Patients With NYHA Class II Systolic Chronic Heart Failure and Left Ventricular Systolic Dysfunction [Internet]

The objective of this systematic review was to evaluate the beneficial and harmful effects of eplerenone 25 mg to 50 mg daily for the treatment of patients with New York Heart Association (NYHA) class II systolic chronic heart failure (HF) and left ventricular systolic dysfunction.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: October 2014
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Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158 998 patients

The review concluded that treatment with angiotensin-converting enzyme inhibitors resulted in a significant further reduction in all-cause mortality in patients with hypertension. The authors’ conclusions were based on the evidence and seem reliable but the unclear quality of the evidence base should be considered when interpreting the review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

A systematic review of angiotensin receptor blockers in preventing stroke

The authors concluded that angiotensin receptor blockers were beneficial in preventing stroke compared with placebo, but there was no evidence of benefit compared with angiotensin-converting enzyme inhibitors and calcium antagonists. The authors’ conclusions appeared to reflect the evidence available but, given the potential for bias in the review and the uncertainty regarding statistical heterogeneity, they should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Safety and tolerability of angiotensin-converting enzyme inhibitor versus the combination of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker in patients with left ventricular dysfunction: a systematic review and meta-analysis of randomized controlled trials

The authors concluded that treatment of left ventricular dysfunction or heart failure with angiotensin-converting enzyme inhibitors (ACEI) plus angiotensin receptor blockers significantly increases the risk of adverse events leading to discontinuation of therapy, compared to ACEI alone. Unexplained discrepancies in the sample numbers and the poor reporting of adverse events in the primary studies necessitate some caution in interpretation of the findings.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Meta-analysis: angiotensin-receptor blockers in chronic heart failure and high-risk acute myocardial infarction

This review evaluated the efficacy of angiotensin-receptor blockers (ARBs) in patients with chronic heart failure and high-risk acute myocardial infarction. The authors concluded that there was no difference between ARBs and angiotensin-converting enzyme inhibitors in reducing all-cause mortality and hospitalisation for heart failure. The review was relatively well-conducted, although the authors did not consider differences in the dosages evaluated across the included studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Systematic review of the effect of telmisartan on insulin sensitivity in hypertensive patients with insulin resistance or diabetes

This review found that telmisartan conferred significant beneficial effects on fasting plasma glucose and adinopectin levels in patients with hypertension and either insulin resistance or type 2 diabetes mellitus. The lack of a thorough quality assessment and other limitations of the review make the reliability of the authors' conclusions uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

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