Hypertension: ARBs may be superior to ACE inhibitors in preventing stroke

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Angiotensin II receptor blockers (ARBs) are as effective as angiotensin-converting enzyme (ACE) inhibitors against the risk of MI and mortality, and slightly more protective than ACE inhibitors in preventing stroke, according to a study in the July issue of the Journal of Hypertension.

Gianpaolo Reboldi, MD, and colleagues from Santa Maria della Misericordia in Perugia, Italy, conducted a meta-analysis of randomized comparative trials between ARBs and ACE inhibitors.

The researchers examined criteria from peer-reviewed journals indexed in Medline, randomized comparison of ARBs vs. ACE inhibitors, or ARBs + ACE inhibitors vs. ACE inhibitors, of patients who reported major complications including MI, stroke, cardiovascular mortality or all-cause mortality. They followed 200 patients for an average of at least one year.

The investigators included six trials for a total of 49,924 patients.

In the pooled estimate, the authors wrote that there were no significant differences between ARBs and ACE inhibitors on the risk of MI, cardiovascular mortality and total mortality.

Overall, Reboldi and colleagues found that the risk of stroke was slightly lower with ARBs than ACE inhibitors. The researchers wrote that the “blockade of the renin-angiotensin system by antagonizing AT1 receptor stimulation by angiotensin II may be associated with a slightly superior cerebrovascular protective effect than blockade of ACE.”

Reboldi and colleagues concluded that the specific effect against stroke “might favor ARB treatment when the risk of stroke is predominant over that of other cardiovascular events such as in Asian patients or in patients with a history of cerebrovascular events.”