Title |
Angiotensin-Converting Enzyme Inhibitors in Hypertension To Use or Not to Use?
|
---|---|
Published in |
JACC, April 2018
|
DOI | 10.1016/j.jacc.2018.01.058 |
Pubmed ID | |
Authors |
Franz H. Messerli, Sripal Bangalore, Chirag Bavishi, Stefano F. Rimoldi |
Abstract |
Most guidelines for the management of patients with cardiovascular disease recommend angiotensin-converting enzyme (ACE) inhibitors as first-choice therapy, whereas angiotensin receptor blockers (ARBs) are merely considered an alternative for ACE inhibitor-intolerant patients. The aim of this review was to compare outcomes and adverse events between ACE inhibitors and ARBs in patients. In patients with hypertension and hypertension with compelling indications, we found no difference in efficacy between ARBs and ACE inhibitors with regard to the surrogate endpoint of blood pressure and outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. However, ACE inhibitors remain associated with cough and a very low risk of angioedema and fatalities. Overall withdrawal rates because of adverse events are lower with ARBs than with ACE inhibitors. Given the equal outcome efficacy but fewer adverse events with ARBs, risk-to-benefit analysis in aggregate indicates that at present there is little, if any, reason to use ACE inhibitors for the treatment of hypertension or its compelling indications. |
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Geographical breakdown
Country | Count | As % |
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Spain | 38 | 15% |
United States | 29 | 11% |
Venezuela, Bolivarian Republic of | 21 | 8% |
Mexico | 12 | 5% |
Colombia | 10 | 4% |
Peru | 7 | 3% |
Ecuador | 7 | 3% |
Argentina | 5 | 2% |
Chile | 4 | 2% |
Other | 31 | 12% |
Unknown | 97 | 37% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 189 | 72% |
Practitioners (doctors, other healthcare professionals) | 40 | 15% |
Scientists | 21 | 8% |
Science communicators (journalists, bloggers, editors) | 10 | 4% |
Unknown | 1 | <1% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 594 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 98 | 16% |
Student > Master | 66 | 11% |
Student > Ph. D. Student | 38 | 6% |
Researcher | 35 | 6% |
Other | 33 | 6% |
Other | 87 | 15% |
Unknown | 237 | 40% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 147 | 25% |
Pharmacology, Toxicology and Pharmaceutical Science | 49 | 8% |
Biochemistry, Genetics and Molecular Biology | 37 | 6% |
Nursing and Health Professions | 33 | 6% |
Agricultural and Biological Sciences | 19 | 3% |
Other | 51 | 9% |
Unknown | 258 | 43% |