“In view of the high prevalence of hypertension in the general population, widespread use of ACE inhibitors may therefore result in a considerable gain in lives saved,” the authors conclude.
Dr. Laura C. van Vark, with the Erasmus Medical Center in Rotterdam, The Netherlands, and colleagues note that while reduction in cardiovascular morbidity is well established with the use of inhibitors of the renin-angiotensin-aldosterone system (RAAS), their effect on all-cause mortality in hypertension is unclear. They therefore undertook a meta-analysis of all randomized clinical trials that compared RAAS inhibitors with control therapy in different populations in which at least two-thirds of the patients had hypertension.
They identified 20 such trials that included a total of 158,998 patients. The all-cause death rate was 20.9 per 1000 person-years in the RAAS-inhibition group compared to 23.3 per 1000 person-years among control patients (hazard ratio 0.95; p=0.032), the team reports.
“The observed treatment effect resulted entirely from the class of ACE inhibitors,” they found. Specifically, the mortality hazard ratio was 0.90 (p=0.004) with ACE inhibitor treatment, but 0.99 (p=0.683) with AT1 receptor blockers (ARBs).
However, the authors caution that the meta-analysis was not designed as a comparison between ACE inhibitors and ARBs, so the difference between these agents should be seen as a post hoc observation.
Overall, Dr. van Vark and colleagues conclude, “The results of this study provide a convincing argument to improve treatment adherence in the millions of people around the world suffering from hypertension and its sequelae.”