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Renin-angiotensin-aldosterone system blockers and cardiovascular outcomes: a meta-analysis of randomized clinical
Pınar Kızılırmak1, Yağız Üresin, Oktay Özdemir
1Department of Pharmacology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey. pkizilirmak@gmail.com.
Insights
Renin-angiotensin-aldosterone system (RAAS) blockers significantly reduce cardiovascular risks compared to other treatments. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) show comparable effectiveness in managing hypertension outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Hypertension is a primary modifiable risk factor for cardiovascular and cerebrovascular diseases.
- Effective management of hypertension is crucial for reducing morbidity and mortality.
Purpose of the Study:
- To evaluate the impact of renin-angiotensin-aldosterone system (RAAS) blockade on cardiovascular outcomes.
- To compare the efficacy of different RAAS blockers.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Inclusion of randomized clinical trials comparing RAAS blockers (ARBs, ACEIs) against placebo or active treatments.
- Analysis of head-to-head trials comparing ARBs and ACEIs for cardiovascular events and mortality.
Main Results:
- RAAS blockers demonstrated significant risk reduction for major cardiovascular outcomes, including mortality, myocardial infarction, heart failure, and stroke.
- Fifty-four pairwise comparisons from 51 trials involving 277,609 patients were analyzed.
- No significant difference was found between angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) for cardiovascular outcomes.
Conclusions:
- RAAS blockers are superior to non-RAAS blocking medications in improving cardiovascular outcomes for hypertensive patients.
- Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer comparable benefits regarding cardiovascular outcomes.
Objective:
Hypertension is the most prevalent modifiable risk factor for cardiovascular (CV) and cerebrovascular morbidity and mortality. This study aimed to assess the effects of renin-angiotensin-aldosterone system (RAAS) blockade on CV outcomes.
Methods:
This study was designed according to the Preferred Reporting Items for Systemic reviews and Meta-Analyses statement. Databases were searched for articles published as of December 2014. Two sets of studies were selected. One set included randomized clinical trials comparing RAAS blocker (angiotensin II receptor blocker [ARB] or angiotensin-converting enzyme inhibitor [ACEI]) with placebo or active treatment. Second set included head-to-head randomized clinical trials comparing an ARB with an ACEI. Studies in both sets had reported any CV outcome parameter or death, i.e., all-cause mortality, CV mortality, emergence of CV events, myocardial infarction, cerebrovascular event, stroke, heart failure, and hospitalization for heart failure.
Results:
Fifty-four pairwise comparisons of 51 trials with 277,609 patients were included. Statistically significant differences in favor of RAAS blockers vs non-RAAS blockers (risk ratio [RR] ranging from 0.805 to 0.967) were observed in terms of most CV outcomes, including all-cause mortality, CV mortality, CV events, myocardial infarction, heart failure and stroke. ARBs and ACEIs were found to be completely comparable (RR ranging from 0.923 to 1.090, all non-significant).
Conclusion:
RAAS blockers are superior to medications other than RAAS blockers with respect to impact on CV outcomes in patients with hypertension. ARBs and ACEIs are comparable in terms of these outcomes.
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