Are ACE-Inhibitors Superior to Angiotensin-II-Receptor-Blockers in the Treatment of Hypertension Regarding Clinically Relevant Endpoints?german translation / full article
A meta-analysis recently published in the European Heart Journal points in the direction that Angiotensin-II-receptor-blockers (ARB) are inferior to ACE-inhibitors (ACEI) in the treatment of hypertension. What is considered current best evidence regarding this comparison?
The meta-analysis primarily shows that treatment of hypertension with any RAAS-inhibitor leads to a significant reduction in cardiovascular and all-cause mortality. From a subgroup-analysis it may be possible that this effect is restricted primarily or even exclusively to ACEI. Due to a lack of head-to-head-studies comparing ACEI and ARB directly, the question of superiority of ACEI or ARB cannot be answered conclusively. The hints from the recent meta-analysis that ACEI may be superior to ARB regarding clinically relevant endpoints should, however, prompt us to intensify research in this area, and to treat patients with hypertension primarily with ACEI. The prescription of ARB should – not only for economical reasons – be restricted to patients who experience adverse drug reactions to ACEI.