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Comparative efficacy of ACE inhibitors and angiotensin receptor antagonists: Review meta-analyses and direct comparative studies

Ageev F. T., Ovchinnikov A. G.
Federal State Budgetary Institution, “Russian Cardiology Research and Production Complex” of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: angiotensin receptor blockers, ACE inhibitors, treatment, meta-analysis, 
preventive measures, randomized clinical studies, cardiovascular diseases

DOI: 10.18087/rhj.2014.5.2006

The article analyzes data of comparative studies and meta-analyses of using ACEI and angiotensin receptor antagonists (ARA) for prevention of cardiovascular complications. The hypothesis that ACEIs are superior to ARA based on “virtual” comparison of results from different studies, which underlies several meta-analyses, does not have sufficient evidence and is not supported by results of comparative studies. Results of direct comparisons obtained in such studies, including ONTARGET, and the meta-analysis of direct comparative studies by G. Reboldi and co-authors showed that ARA are not inferior to ACEI by the capability for reducing the risk of acute MI, cardiovascular and all-cause death and is probably even superior by the effect on the risk of acute cerebrovascular disease. Moreover, considering the undoubtedly better tolerability and safety of ARA, these drugs can claim to be considered as first-line drugs for prevention and treatment of cardiovascular complications in patients with AH and high risk of cardiovascular complications.
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Ageev F. T., Ovchinnikov A. G. Comparative efficacy of ACE inhibitors and angiotensin receptor antagonists: Review meta-analyses and direct comparative studies. Russian Heart Journal. 2014;79 (5):308–316

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