First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for hypertension

Review of 45 RCTs (n=66,625) concludes whilst all‐cause death is similar for first‐line renin angiotensin system (RAS) inhibitors, first‐line CCBs, thiazides and beta‐blockers, first‐line thiazides cause less HF and stroke vs first‐line RAS inhibitors.

Low‐quality evidence suggests that first‐line RAS inhibitors reduced stroke and total CV events compared to first‐line beta‐blockers. Additionally, first‐line CCBs increased HF but decreased stroke vs first‐line RAS inhibitors (but magnitude of increase in HF exceeded the decrease in stroke).

 

Currently, NICE clinical guidelines on the management of hypertension recommends treatment with an angiotensin-converting enzyme (ACE) inhibitor, or if an ACE inhibitor is not tolerated, an angiotensin receptor blocker, in patients under 55 years.