Cardiology Letters 2015, 24(2):70-76

Differences between renin-angiotensin-aldosterone system inhibitors according to their impact on mortality and major cardiovascular events in hypertension

Remková A

Lekárská fakulta SZU Bratislava, I. interná klinika SZU a UNB Bratislava, Slovenská republika

The renin-angiotensin-aldosterone system (RAAS), essential for the regulation of blood pressure, cardiovascular and renal function, is a key therapeutic target in hypertension. A series of the latest metaanalyses from large hypertension trials has shown that RAAS inhibitors significantly reduce relative risk for all-cause and cardiovascular mortality. Separately, angiotensin-converting enzyme (ACE) inhibitors produce a significant reduction in relative risk for all-cause mortality and a trend toward a significant reduction in cardiovascular mortality, whereas angiotensin II receptor blockers (ARBs) have no effect. All meta-analyses almost consistently have found that, while ACE inhibitors prevent coronary events with reductions in cardiovascular morbidity and all-cause mortality, ARBs are, at best, efficient only for the prevention of stroke. These results provide proof of clear differences in the cardioprotection afforded by these two antihypertensive classes. The evidence from meta-analyses suggests that in hypertension ACE inhibitors should be considered ahead of ARBs, and ARBs restricted to patients intolerant of ACE inhibitors.

Keywords: hypertension; ACE-inhibitor; angiotensin II receptor blocker; mortality

Published: February 1, 2015  Show citation