Excerpt

In this comparative effectiveness review, we examine the scientific literature on angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor antagonists (ARBs, or angiotensin receptor blockers) for individuals with hypertension regarding their relative benefits (blood pressure control, cardiovascular risk reduction, cardiovascular events, quality of life, and other outcomes), as well as relative risks (safety, adverse events, tolerability, persistence, and adherence). In addition, we will examine the clinical determinants of these outcomes with a focus on the long-term impact.

Contents

• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • Background
  • Scope and Key Questions
• 2. Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Extraction
  • Quality Assessment
  • Applicability
  • Rating the Body of Evidence
  • Data Synthesis
• 3. Results
  • Literature Search and Screening
  • Key Question 1. For adult patients with essential hypertension, how do ACEIs and ARBs differ in blood pressure control, cardiovascular risk reduction, cardiovascular events, quality of life, and other outcomes?
  • Key Question 2. For adult patients with essential hypertension, how do ACEIs and ARBs differ in safety, adverse events, tolerability, persistence, and adherence?
  • Key Question 3. Are there subgroups of patients based on demographic characteristics (age, racial and ethnic groups, sex), use of other medications concurrently, or comorbidities for which ACEIs or ARBs are more effective, associated with fewer adverse events, or better tolerated?
• 4. Summary and Discussion
• 5. Future Research
• References
• Abbreviations
• Appendixes
  • Appendix A Exact Search Strings
  • Appendix B Methods for Reviewing Indirect Comparison Studies
  • Appendix C Abstract and Full-Text Screening Criteria
  • Appendix D Data Abstraction Form
  • Appendix E Evidence Table
  • Appendix F Applicability Criteria
  • Appendix G List of Excluded Direct Comparator Studies

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-02-0025. Prepared by: Duke Evidence-based Practice Center.

Suggested citation:

Matchar DB, McCrory DC, Orlando LA, Patel MR, Patel UD, Patwardhan MB, Powers B, Samsa GP, Gray RN. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension. Comparative Effectiveness Review No. 10. (Prepared by Duke Evidence-based Practice Center under Contract No. 290-02-0025.) Rockville, MD: Agency for Healthcare Research and Quality. November 2007. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

This report is based on research conducted by the Duke Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0025). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

This report is intended as a reference and not as a substitute for clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

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