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Equal or Preferred Substitutes for ACE Inhibitors?

Arch Intern Med. 2000;160:1905-1911.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

LONG-TERM studies with ACE inhibitors documenting efficacy in reducing cardiovascular morbidity and mortality in patients with hypertension are scarce.^1-3 However, there is compelling evidence from prospective studies^4-5 in patients with CHF and diabetic nephropathy that ACE inhibitors may be beneficial. Several prospective ongoing studies (Table 1) with ACE inhibitors and ARBs are ongoing, but the results of these studies will not be available for a few more years. Meanwhile, the practicing physician still faces the question: should ACE inhibitors or ARBs be preferred as a first-line therapy in hypertension? To answer this question, we will examine the evidence that has convinced the Joint National Committee VI⁶ and the World Health Organization–International Society of Hypertension (WHO-ISH) Committee⁷ to consider ACE inhibitors and ARBs as first-line therapies.

Table appears in full text version. Table 1. Ongoing End Point Trials of Angiotensin II Receptor Blockers*

THE ROLE OF THE RAAS IN THE PATHOGENESIS OF HYPERTENSION AND END-ORGAN DAMAGE

The renin-angiotensin-aldosterone system (RAAS) has been shown to participate in the pathophysiology . . . [Full Text of this Article]

THE EFFECTS OF BLOCKING THE RAAS

Antihypertensive Effect

Metabolic and Neurohormonal Effects

Cardiac Effects

Reduction of Left Ventricular Hypertrophy

Congestive Heart Failure

Renal Effects

Tolerability and Adverse Effects

Angioedema

COMBINATION WITH OTHER ANTIHYPERTENSIVE AGENTS

COMBINATION OF ARBs AND ACE INHIBITORS

COST

OUTCOME STUDIES

SUMMARY

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