OtherEvidence-Based Clinical Medicine
Are Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Especially Useful for Cardiovascular Protection?
Hean Teik Ong
The Journal of the American Board of Family
Medicine November 2009, 22 (6) 686-697; DOI: https://doi.org/10.3122/jabfm.2009.06.090094
Hean Teik Ong
FRCP, FACC, FESC

References
- ↵Sleight P, Yusuf S. New evidence on the importance of the rennin-angiotensin system in the treatment of higher-risk patients with hypertension. J Hypertens 2003; 21: 1599–608.
- Weir MR. Effects of rennin-angiotensin system inhibition on end-organ protection: can we do better? Clin Ther 2007; 29: 1803–24.
- Stojiljkovic L, Behnia R. Role of rennin angiotensin system inhibitors in cardiovascular and renal protection: a lesson from clinical trials. Curr Pharm Des 2007; 13: 1335–445.
- Julius S, Nesbitt SD, Egan BM, et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med 2006; 354: 1685–97.
- ↵The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–59.
- ↵Barter PJ, Caulfield M, Eriksson M, et al. Effects of torcetrapid in patients at high risk of coronary events. N Engl J Med 2007; 357: 2109–22.
- ↵UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317: 713–20.
- ↵Hansson L, Lindholm LH, Niskanen L, et al. Effect of ACE inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: The Captopril Prevention Project (CAPPP). Lancet 1999; 353: 611–6.
- ↵Hansson L, Lindholm LH, Ekbom T, et al. Randomized trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension 2 (STOP- Hypertension 2) study. Lancet 1999; 354: 1751–6.
- ↵Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
- ↵The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97.
- ↵Wing LMH, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin coverting enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003; 348: 583–92.
- ↵Yui Y, Sumiyoshi T, Kodama K, et al. Comparison of nifedipine retard with angiotensin-converting enzyme inhibitors in Japanese hypertensive patients with coronary artery disease: the Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) randomized trial. Hypertens Res 2004; 27: 181–91.
- ↵Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet 2004; 363: 2022–31.
- ↵UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13.
- ↵ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Diuretic versus alpha-blocker as first-step antihypertensive therapy: final results from the Antihypertesnive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension 2003; 42: 239–46.
- ↵Barzilay JI, Davis BR, Bettencourt J, et al. Cardiovascular outcomes using doxazosin vs chlorthalidone for the treatment of hypertension in older adults with and without glucose disorders: a report from the ALLHAT Study. J Clin Hypertens 2004; 6: 116–25.
- Whelton PK, Barzilay J, Cushman WC, et al. Clinical outcomes in antihypertensive treatment of type 2 diabetes, impaired fasting glucose concentration, and normoglycemia. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 2005; 165: 1401–9.
- Rahman M, Pressel S, Davis BR, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the ALLHAT Study. Arch Inten Med 2005; 165: 936–46.
- Wright JT, Dunn JK, Cutler JA, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA 2005; 293: 1595–607.
- ↵Williams B. Drug treatment for hypertension: most patients will need a treatment cocktail—including a thiazide diuretic. BMJ 2003; 326: 61–2.
- Moser M. Results of ALLHAT. Is this the final answer regarding initial anti-hypertensive drug therapy? Arch Intern Med 2003; 163: 1269–73.
- Appel LJ. The verdict from ALLHAT—Thiazide diuretics are the preferred initial therapy for hypertension. JAMA 2002; 288: 3039–42.
- Davis BR, Furberg CD, Wright JT Jr, Cutler JA, Whelton P. ALLHAT: setting the record straight. Ann Intern Med 2004; 141: 39–46.
- ↵Shinoda E, Yui Y, Kodama K, et al. Japan Multicenter Investigation for Cardiovascular Diseases-B Study Group. Quantitative coronary angiogram analysis: nifedipine retard versus angiotensin-converting enzyme inhibitors (JMIC-B side arm study). Hypertension 2005; 45: 1153–8.
- ↵The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145–53.
- ↵PROGRESS collaborative group. Randomised trial of a perindopril-based blood pressure lowering regimen among 6105 individuals with previous stroke or transient ischemic attack. Lancet 2001; 358: 1033–41.
- ↵The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782–88.
- ↵Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure. The CAMELOT Study: a randomized controlled trial. JAMA 2004; 292: 2217–26.
- ↵The PEACE Trial Investigators. Angiotensin-converting enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351: 2058–68.
- ↵Mochizuki S, Dahlof B, Shimizu M, et al. Valsartan in a Japanese population with hypertension and other cardiovascular disease (Jikei Heart Study): a randomized, open-label, blinded end-point morbidity-mortality study. Lancet 2007; 369: 1431–9.
- ↵Svensson P, de Faire U, Sleight P, Yusuf S, Ostergren J. Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE substudy. Hypertension 2001; 38: 28–32.
- ↵
- ↵
- ↵
- ↵
- ↵Wennberg R, Zimmermann C. The PROGRESS trial three years later: time for a balanced report of effectiveness. BMJ 2004; 329: 968–70.
- ↵MacMahon S, Neal B, Rodgers A, Chalmers J. The PROGRESS trial three years later: time for more action, less distraction. BMJ 2004; 329: 970–1.
- ↵Lindholm LH, Ibsen H, Dahlof B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 1004–10.
- ↵
- ↵Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet 2004; 364: 1684–9.
- Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ 2006; 174: 1737–42.
- Lindholm LH, Carlberg B, Samuelsson O. Should beta-blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005; 366: 1545–53.
- ↵Kjeldsen SE, Julius S, Brunner H, et al. Characteristics of 15314 hypertensive patients at high coronary risk. The VALUE Trial. Blood Press 2001; 10: 83–91.
- ↵Weber MA, Julius S, Kjeldsen SE, et al. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE Trial. Lancet 2004; 363: 2049–51.
- ↵Staessen JA, Richart T. Sum and substance in the Jikei heart study. Lancet 2007; 369: 1407–8.
- ↵The Telmisartan Randomised Assessment Study in ACE-Intolerant Subjects with Cardiovascular Disease (TRANSCEND) investigators. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomized controlled trial. Lancet 2008; 372: 1174–83.
- ↵
- ↵The ONTARGET Investigators. Telmisartan, ramipril or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547–59.
- ↵Mann JFE, Schmeider RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both in people at high vascular risk (the ONTARGET study): a multicentre, randomized, double-blind, controlled trial. Lancet 2008; 372: 547–53.
- ↵
- ↵Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289: 2560–72.
- Whitworth JA, World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21: 1983–92.
- Williams B, Poulter NR, Brown MJ, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004; 18: 139–85.
- Mancia G, de Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension. Eur Heart J 2007; 28: 1462–536.
- ↵Pepine CJ. What is the optimal blood pressure and drug therapy for patients with coronary artery disease? JAMA 2004; 292: 2271–3.
- Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–13.
- Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345: 1291–7.
- Alder AI, Stratton IM, Neil HA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321: 412–9.
- ↵Daviglus ML, Liu K. Today's Agenda. We must focus on achieving favorable levels of all risk factors simultaneously. Arch Intern Med 2004; 164: 2086–7.
- ↵Pitt B. ACE Inhibitors for patients with vascular disease without left ventricular dysfunction—may they rest in PEACE? N Engl J Med 2004; 351: 2115–7.
In this issue
The Journal of the American Board of Family
Medicine
Vol. 22, Issue 6
November-December 2009
Are Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Especially Useful for Cardiovascular Protection?
Hean Teik Ong
The Journal of the American Board of Family
Medicine Nov 2009, 22 (6) 686-697; DOI: 10.3122/jabfm.2009.06.090094
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