Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of reninangiotensinaldosterone system inhibitors involving 158 998 patients

Laura Vark, M Bertrand, Martijn Akkerhuis, Jasper Brugts, K Fox, JJ Mourad, Eric Boersma

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Abstract

Reninangiotensinaldosterone system (RAAS) inhibitors are well established for the reduction in cardiovascular morbidity, but their impact on all-cause mortality in hypertensive patients is uncertain. Our objective was to analyse the effects of RAAS inhibitors as a class of drugs, as well as of angiotensin-converting enzyme (ACE) inhibitors and AT1 receptor blockers (ARBs) separately, on all-cause mortality. We performed a pooled analysis of 20 cardiovascular morbiditymortality trials. In each trial at least two-thirds of the patients had to be diagnosed with hypertension, according to the trial-specific definition, and randomized to treatment with an RAAS inhibitor or control treatment. The cohort included 158 998 patients (71 401 RAAS inhibitor; 87 597 control). The incidence of all-cause death was 20.9 and 23.3 per 1000 patient-years in patients randomized to RAAS inhibition and controls, respect In patients with hypertension, treatment with an ACE inhibitor results in a significant further reduction in all-cause mortality. Because of the high prevalence of hypertension, the widespread use of ACE inhibitors may result in an important gain in lives saved.
Original languageUndefined/Unknown
Pages (from-to)2088-2097
Number of pages10
JournalEuropean Heart Journal
Volume33
Issue number16
DOIs
Publication statusPublished - 2012

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