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A systematic review and network meta-analysis of the comparative efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in hypertension

Journal of Human Hypertension volume 33, pages 188–201 (2019)Cite this article

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Abstract

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are drugs commonly used for the treatment of hypertension. However, studies on their comparative efficacy have not been extensively investigated. The current systematic review and network meta-analysis studied the comparative efficacy of the two antihypertensive treatment categories in reducing blood pressure, mortality, and morbidity in essential hypertension patients. A literature search was carried out in Medline and Cochrane Central Register of Controlled Trials for placebo- and active-controlled, double-blind randomized clinical trials, which had reported blood pressure effects, mortality, and/or morbidity. Blood pressure results were found in 30 studies with 7370 participants and 8 studies with 25,158 participants with mortality/morbidity results included in the analysis. The two drug classes had similar effectiveness in lowering systolic (weighted mean difference (WMD): 0.59, 95% CI: −0.21 to 1.38) and diastolic blood pressure (WMD: 0.62, 95% CI: −0.06 to 1.30), all-cause mortality (risk ratio (RR)): 0.96, 95% CI 0.80 to 1.14), cardiovascular mortality (RR: 0.87, 95% CI 0.67 to 1.14), fatal and non-fatal myocardial infarction (RR: 1.02, 95% CI 0.75 to 1.37) and stroke (RR: 1.13, 95% CI 0.87 to 1.46). Angiotensin-converting enzyme inhibitors were more helpful in the prevention and/or the hospitalization for heart failure than angiotensin receptor blockers (RR: 0.71, 95% CI 0.54 to 0.93). Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were similarly effective in decreasing blood pressure, mortality, and morbidity in essential hypertension. Angiotensin-converting enzyme inhibitors were more protective in the advancement and/or hospitalization of the hypertensive patient for heart failure than angiotensin receptor blockers.

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Authors and Affiliations

  1. 3rd Department of Internal Medicine, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Chrisa Dimou, Christina Antza, Ioannis Doundoulakis & Vasilios Kotsis

  2. 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece

    Chrisa Dimou, Evangelos Akrivos & Ioannis Doundoulakis

  3. Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Evangelos Akrivos

  4. 1st Department of Pediatrics, Hippokration Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece

    Stella Stabouli

  5. Department of Hygiene and Epidemiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Anna Bettina Haidich

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An interim analysis of the results has been presented during the European Society of Hypertension 2018 Congress in Barcelona, Spain.

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Dimou, C., Antza, C., Akrivos, E. et al. A systematic review and network meta-analysis of the comparative efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in hypertension. J Hum Hypertens 33, 188–201 (2019). https://doi.org/10.1038/s41371-018-0138-y

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