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Angiotensin-Converting Enzyme Inhibitors in Hypertension: To Use or Not to Use?
Journal article

Angiotensin-Converting Enzyme Inhibitors in Hypertension: To Use or Not to Use?

  • Messerli FH Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland; Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine, New York, New York. Electronic address: messerli.f@gmail.com.
  • Bangalore S The Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York.
  • Bavishi C Division of Cardiology, Mount Sinai St. Luke's & Mount Sinai West Hospitals, New York, New York.
  • Rimoldi SF Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland.
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  • 2018-03-31
Published in:
  • Journal of the American College of Cardiology. - 2018
adverse events
angioedema
angiotensin receptor blocker
blood pressure
chronic kidney disease
coronary heart disease
cough
diabetes
heart failure
hypertension
left ventricular hypertrophy
Angioedema
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Animals
Antihypertensive Agents
Blood Pressure
Cardiovascular Diseases
Clinical Trials as Topic
Drug Therapy, Combination
Humans
Hypertension
Renin-Angiotensin System
English Most guidelines for the management of patients with cardiovascular disease recommend angiotensin-converting enzyme (ACE) inhibitors as first-choice therapy, whereas angiotensin receptor blockers (ARBs) are merely considered an alternative for ACE inhibitor-intolerant patients. The aim of this review was to compare outcomes and adverse events between ACE inhibitors and ARBs in patients. In patients with hypertension and hypertension with compelling indications, we found no difference in efficacy between ARBs and ACE inhibitors with regard to the surrogate endpoint of blood pressure and outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. However, ACE inhibitors remain associated with cough and a very low risk of angioedema and fatalities. Overall withdrawal rates because of adverse events are lower with ARBs than with ACE inhibitors. Given the equal outcome efficacy but fewer adverse events with ARBs, risk-to-benefit analysis in aggregate indicates that at present there is little, if any, reason to use ACE inhibitors for the treatment of hypertension or its compelling indications.
Language
  • English
Open access status
bronze
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/233407
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