Hypertension mega-trials with cardiovascular end points: effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
BACKGROUND
The renin-angiotensin-aldosterone system has a pivotal role in the short- and long-term regulation of blood pressure through its principal mediator, angiotensin II. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II-receptor blockers (ARBs) decrease the deleterious effects of angiotensin II on the vasculature and heart, but have different mechanisms of action. Although the blood pressure-lowering effect of ACE inhibitors and ARBs is equivalent to that of most other antihypertensive agents, emerging data suggest that these drug classes may have a greater effect on decreasing cardiovascular morbidity and mortality rates in specific patient populations.


METHODS
We reviewed large (approximately > or =5000 patients) hypertension clinical trials using ACE inhibitors and ARBs and with cardiovascular morbidity/mortality end points.


RESULTS
Six trials of ACE inhibitors and 5 trials of ARBs (3 completed, 2 ongoing) were selected for this analysis. Data from these hypertension mega-trials suggest that ACE inhibitors and ARBs may decrease cardiovascular morbidity and mortality rates, especially in patients with diabetes mellitus, renal dysfunction, and left ventricular hypertrophy. However, some trials showed important blood-pressure differences and are therefore partly inconclusive for particular drug effects.


CONCLUSIONS
Analysis of recently reported and ongoing mega-trials of renin-angiotensin-aldosterone system inhibitors may support the notion that their vasculoprotective properties confer greater benefit by virtue of their effects beyond blood-pressure reduction. Results from trials that will be completed in the next few years may provide further support of blocking the renin-angiotensin-system in cardiovascular protection in the management of hypertension.
Kjeldsen
Sverre E
SE
Department of Cardiology, Ullevaal University Hospital, Oslo, Norway.
Julius
Stevo
S
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003920:Diabetes Mellitus; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D007674:Kidney Diseases / Q000150:complications; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D012307:Risk Factors
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents