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Hypertension mega-trials with cardiovascular end points: effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
Am Heart J. 2004 Nov; 148(5):747-54.AH

Abstract

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.

Authors+Show Affiliations

Department of Cardiology, Ullevaal University Hospital, Oslo, Norway.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15523303

Citation

Kjeldsen, Sverre E., and Stevo Julius. "Hypertension Mega-trials With Cardiovascular End Points: Effect of Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers." American Heart Journal, vol. 148, no. 5, 2004, pp. 747-54.
Kjeldsen SE, Julius S. Hypertension mega-trials with cardiovascular end points: effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Am Heart J. 2004;148(5):747-54.
Kjeldsen, S. E., & Julius, S. (2004). Hypertension mega-trials with cardiovascular end points: effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. American Heart Journal, 148(5), 747-54.
Kjeldsen SE, Julius S. Hypertension Mega-trials With Cardiovascular End Points: Effect of Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers. Am Heart J. 2004;148(5):747-54. PubMed PMID: 15523303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertension mega-trials with cardiovascular end points: effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. AU - Kjeldsen,Sverre E, AU - Julius,Stevo, PY - 2004/11/4/pubmed PY - 2005/3/2/medline PY - 2004/11/4/entrez SP - 747 EP - 54 JF - American heart journal JO - Am Heart J VL - 148 IS - 5 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15523303/Hypertension_mega_trials_with_cardiovascular_end_points:_effect_of_angiotensin_converting_enzyme_inhibitors_and_angiotensin_receptor_blockers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S000287030400290X DB - PRIME DP - Unbound Medicine ER -