Evidence of Benefits
Similar long-term blood pressure-lowering effects were seen with ACEIs and ARBs. Image clinacei2fu1.jpg
The DRI aliskiren may be slightly more effective at reducing blood pressure than an ACEI (ramipril); however, no differences were detected between aliskiren and an ARB (losartan). Image clinacei2fu3.jpg
No significant differences were found between ACEIs and ARBs for these outcomes:
  • Mortality and major cardiovascular events Image clinacei2fu3.jpg
  • Rate of monotherapy success Image clinacei2fu1.jpg
  • Quality-of-life measures Image clinacei2fu3.jpg
  • Progression of renal disease Image clinacei2fu2.jpg
  • Effects on LVMI or LVEF Image clinacei2fu3.jpg
ACEIs and ARBs are similar in their lack of effect on serum lipid levels, blood glucose levels, and HbA1c. Image clinacei2fu2.jpg
Evidence was insufficient for all other outcomes beyond blood pressure reduction on the comparative effectiveness of the DRI aliskiren. Image clinacei2fu4.jpg
Evidence of Adverse Effects
Cough is more prevalent in patients on ACEIs than those on ARBs (About 9% of patients treated with an ACEI and about 2% of patients treated with an ARB report a cough). Image clinacei2fu1.jpg
ACEIs were associated with lower rates of persistence and higher rates of withdrawals due to adverse events when compared with ARBs. Image clinacei2fu2.jpg
Angioedema was uncommon and most frequently associated with ACEIs. Image clinacei2fu3.jpg

HbA1c = hemoglobin A1c; LVEF = left ventricular ejection fraction; LVMI = left ventricular mass index

Strength of Evidence Scale

High: Image clinacei2fu1.jpg There are consistent results from good-quality studies. Further research is very unlikely to change the conclusions.

Moderate: Image clinacei2fu2.jpg Findings are supported, but further research could change the conclusions.

Low: Image clinacei2fu3.jpg There are very few studies, or existing studies are flawed.

Insufficient: Image clinacei2fu4.jpg Research is either unavailable or does not permit estimation of a treatment effect.

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