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Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertensionHeran BS, Wong MMY, Heran IK, Wright JM
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SummaryACE inhibitors for the treatment of elevated blood pressureThe class of drugs called ACE inhibitors is commonly used for the treatment of elevated blood pressure (BP). This class includes drugs such as ramipril, captopril, enalapril, fosinopril, lisinopril and quinapril. We asked how much this class of drugs lowers BP and whether there is a difference between individual drugs within this class. The available scientific literature was searched to find all the trial evidence to assess this question. Ninety two trials that randomly assigned participants to take either an ACE inhibitor or an inert substance (placebo) were identified. These trials evaluated the BP lowering ability of 14 different ACE inhibitors in 12 954 participants who were followed for approximately 6 weeks. No ACE inhibitor appears to be any better or worse in terms of BP lowering ability and most of the BP lowering effect occurs with the starting doses of these drugs. The best estimate of the trough BP lowering effect was -8/-5 mm Hg. Due to lack of reporting and the short duration of these trials this review did not provide a good estimate of the harms associated with this class of drugs.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 08. 2008 AbstractBackgroundACE inhibitors are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAE). ObjectivesTo quantify the dose-related systolic and/or diastolic BP lowering efficacy of ACE inhibitors versus placebo in the treatment of primary hypertension. Search strategyWe searched CENTRAL (The Cochrane Library 2007, Issue 1), MEDLINE (1966 to February 2007), EMBASE (1988 to February 2007) and reference lists of articles. Selection criteriaDouble-blind, randomized, controlled trials evaluating the BP lowering efficacy of fixed-dose monotherapy with an ACE inhibitor compared with placebo for a duration of 3 to 12 weeks in patients with primary hypertension. Data collection and analysisTwo authors independently assessed the risk of bias and extracted data. Study authors were contacted for additional information. WDAE information was collected from the trials. Main resultsNinety two trials evaluated the dose-related trough BP lowering efficacy of 14 different ACE inhibitors in 12 954 participants with a baseline BP of 157/101 mm Hg. The data do not suggest that any one ACE inhibitor is better or worse at lowering BP. A dose of 1/8 or 1/4 of the manufacturer's maximum recommended daily dose (Max) achieved a BP lowering effect that was 60 to 70% of the BP lowering effect of Max. A dose of 1/2 Max achieved a BP lowering effect that was 90% of Max. ACE inhibitor doses above Max did not significantly lower BP more than Max. Combining the effects of 1/2 Max and higher doses gives an estimate of the average trough BP lowering efficacy for ACE inhibitors as a class of drugs of -8 mm Hg for SBP and -5 mm Hg for DBP. ACE inhibitors reduced BP measured 1 to 12 hours after the dose by about 11/6 mm Hg. Authors' conclusionsThere are no clinically meaningful BP lowering differences between different ACE inhibitors. The BP lowering effect of ACE inhibitors is modest; the magnitude of trough BP lowering at one-half the manufacturers' maximum recommended dose and above is -8/-5 mm Hg. Furthermore, 60 to 70% of this trough BP lowering effect occurs with recommended starting doses. The review did not provide a good estimate of the incidence of harms associated with ACE inhibitors because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials. |
