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Meta-Analysis
. 2007 May;25(5):951-8.
doi: 10.1097/HJH.0b013e3280bad9b4.

Blood Pressure-Dependent and Independent Effects of Agents That Inhibit the Renin-Angiotensin System

Meta-Analysis

Blood Pressure-Dependent and Independent Effects of Agents That Inhibit the Renin-Angiotensin System

Blood Pressure Lowering Treatment Trialists' Collaboration et al. J Hypertens. .

Erratum in

  • J Hypertens. 2007 Jul;25(7):1524

Abstract

Objectives: To evaluate the blood pressure-dependent and independent effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on major cardiovascular events.

Methods: Using data from 26 large-scale trials comparing an ACEI or an ARB with placebo or another drug class, meta-regression analyses were conducted in which treatment-specific relative risks for major cause-specific outcomes [stroke, major coronary heart disease (CHD) events and heart failure] were regressed against follow-up blood pressure differences.

Results: From a total of 146 838 individuals with high blood pressure or an elevated risk of cardiovascular disease, 22 666 major cardiovascular events were documented during follow-up. The analyses showed comparable blood pressure-dependent reductions in risk with ACEI and ARB (P >or= 0.3 for all three outcomes). The analyses also showed that ACEI produced a blood pressure-independent reduction in the relative risk of CHD of approximately 9% (95% confidence interval 3-14%). No similar effect was detected for ARB, and there was some evidence of a difference between ACEI and ARB in this regard (P = 0.002). For both stroke and heart failure there was no evidence of any blood pressure-independent effects of either ACEI or ARB.

Conclusion: There are similar blood pressure-dependent effects of ACEI and ARB for the risks of stroke, CHD and heart failure. For ACEI, but not ARB, there is evidence of blood pressure-independent effects on the risk of major coronary disease events.

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