Article ; Online: The Pivotal Role of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Hypertension Management and Cardiovascular and Renal Protection: A Critical Appraisal and Comparison of International Guidelines.
American journal of cardiovascular drugs : drugs, devices, and other interventions
2023 Volume 23, Issue 6, Page(s) 663–682
Abstract: Arterial hypertension is the main preventable cause of premature mortality worldwide. Across Latin America, hypertension has an estimated prevalence of 25.5-52.5%, although many hypertensive patients remain untreated. Appropriate treatment, started early ...
| Abstract | Arterial hypertension is the main preventable cause of premature mortality worldwide. Across Latin America, hypertension has an estimated prevalence of 25.5-52.5%, although many hypertensive patients remain untreated. Appropriate treatment, started early and continued for the remaining lifespan, significantly reduces the risk of complications and mortality. All international and most regional guidelines emphasize a central role for renin-angiotensin-aldosterone system inhibitors (RAASis) in antihypertensive treatment. The two main RAASi options are angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs). Although equivalent in terms of blood pressure reduction, ACEis are preferably recommended by some guidelines to manage other cardiovascular comorbidities, with ARBs considered as an alternative when ACEis are not tolerated. This review summarizes the differences between ACEis and ARBs and their place in the international guidelines. It provides a critical appraisal of the guidelines based on available evidence from randomized controlled trials (RCTs) and meta-analyses, especially considering that hypertensive patients in daily practice often have other comorbidities. The observed differences in cardiovascular and renal outcomes in RCTs may be attributed to the different mechanisms of action of ACEis and ARBs, including increased bradykinin levels, potentiated bradykinin response, and stimulated nitric oxide production with ACEis. It may therefore be appropriate to consider ACEis and ARBs as different antihypertensive drugs classes within the same RAASi group. Although guideline recommendations only differentiate between ACEis and ARBs in patients with cardiovascular comorbidities, clinical evidence suggests that ACEis provide benefits in many hypertensive patients, as well as those with other cardiovascular conditions. |
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| MeSH term(s) | Humans ; Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Angiotensin Receptor Antagonists/pharmacology ; Angiotensin Receptor Antagonists/therapeutic use ; Bradykinin/pharmacology ; Bradykinin/therapeutic use ; Hypertension ; Antihypertensive Agents/pharmacology ; Antihypertensive Agents/therapeutic use ; Renin-Angiotensin System |
| Chemical Substances | Angiotensin-Converting Enzyme Inhibitors ; Angiotensin Receptor Antagonists ; Bradykinin (S8TIM42R2W) ; Antihypertensive Agents |
| Language | English |
| Publishing date | 2023-09-05 |
| Publishing country | New Zealand |
| Document type | Journal Article ; Review |
| ZDB-ID | 2052547-3 |
| ISSN | 1179-187X ; 1175-3277 |
| ISSN (online) | 1179-187X |
| ISSN | 1175-3277 |
| DOI | 10.1007/s40256-023-00605-5 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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