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Expert Rev Cardiovasc Ther. 2013 Jun;11(6):705-17. doi: 10.1586/erc.13.42.

The impact of ACE inhibition on all-cause and cardiovascular mortality in contemporary hypertension trials: a review.

Author information

1
Department of Cardiology and LTTA Centre, University Hospital of Ferrara, Italy. fri@unife.it

Abstract

The renin-angiotensin-aldosterone system is a key therapeutic target in hypertension. The latest meta-analysis of mortality reduction with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in hypertension features 158,998 patients from 20 contemporary hypertension trials. ACE inhibitors and ARBs significantly reduced relative risk for all-cause mortality by 5% (p = 0.032) and cardiovascular mortality by 7% (p = 0.018) in populations with a high prevalence of hypertension (≥66%). ACE inhibitors produced a 10% reduction in relative risk for all-cause mortality (p = 0.004) and a trend toward a 12% reduction in cardiovascular mortality (p = 0.051), whereas ARBs had no effect. On balance, mortality evidence suggests that in hypertension, ACE inhibitors should be considered ahead of ARBs, and ARBs restricted to patients intolerant of ACE inhibitors.

PMID:
23750680
DOI:
10.1586/erc.13.42
[Indexed for MEDLINE]

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