Angiotensin converting enzyme inhibitor (ACEI) is an important type of antihypertensive drug. Much evidence shows that ACEI not only decreases the blood pressure but also has the protective effect on the cardiac and cerebral vessels. ACEI may prevent the stroke. To provide the best evidence for the clinical practice, we electronically searched RCTs and systematic reviews from MEDLINE and The Cochrane Library to evaluate the mechanisms and the effects of ACEI in stroke treatment and prevention.
Objective To compare the effectiveness and safety of angiotensin receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) for coronary heart disease (CHD). Methods Randomized controlled trials (RCTs) on ARB vs. ACEI in treating CHD were collected in databases including MEDLINE, EMbase, BIOSIS Previews, The Cochrane Library, CBM, VIP, WanFang Data and CNKI from inception to July 2011, and the references of the included articles were also retrieved. In accordance with the Cochrane Handbook 5.0.1, two reviewers independently evaluated the quality of articles, and extracted and cross-checked the data. Then meta-analysis was performed using RevMan 5.1.1 software. Results A total of 18 RCTs (17 660 cases) were included. The results of meta-analysis showed that there were no significant differences between the ARB group and the ACEI group in all-cause mortality (RR=1.04, 95%CI 0.98 to 1.11, P=0.20), cardiovascular mortality (RR=1.04, 95%CI 0.97 to 1.12, P=0.26), myocardial infarction (RR=0.98, 95%CI 0.92 to 1.05, P=0.59), hospitalization for heart failure (RR=1.14, 95%CI 0.97 to 1.32, P=0.11) and stroke (RR=0.93, 95%CI 0.80 to 1.08, P=0.34). However, the risk of adverse events causing drug discontinuation was significantly lower in the ARB group compared with the ACEI group (RR=0.77, 95%CI 0.67 to 0.89, P=0.000 3). Conclusion Current evidence suggests that ARB is as effective as ACEI in reducing the risk of all-cause mortality, cardiovascular mortality, myocardial infarction, hospitalization for heart failure and stroke in patients with coronary heart disease. Moreover, it is much better in tolerance. Because of the quality limitation and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective clinical trials.
Objective To systematically evaluate the effectiveness and safety of calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) used alone v.s. used in combination on the reversion of left ventricular hypertrophy (LVH) in Chinese essential hypertension (EH) patients. Methods The following databases were searched, including, Cochrane Library (Issue 7, 2011), PubMed (1980 to 2011), EMbase (1990 to 2011), CBM (1978 to 2011), CNKI (1994 to 2011), VIP (1989 to 2011), and WanFang Data (1998 to 2011). The studies were screened, and the quality was evaluated according to predefined inclusion and exclusion criteria, and then Meta-analysis was conducted by using RevMan 5.1 software. Results A total of 10 studies involving 859 patients were included. The results of Meta-analysis showed that the CCBs plus ACEIs group (the combination group) was superior to the CCBs group in improving EH patients’ systolic pressure (SBP) (MD= –6.49, 95%CI –10.55 to –2.43), diastolic pressure (DBP) (MD= –4.48, 95%CI –6.76 to –2.21), left ventricular mass index (LVMI) (MD= –5.31, 95%CI –8.43 to –2.19), interventricular septal thickness (IVST) (MD= –1.33, 95%CI –2.00 to –0.66) and left ventricular posterior wall thickness (LVPWT) (MD= –0.87, 95%CI –1.41 to –0.33). In addition, compared with the ACEIs group, the combination group was greatly superior in decreasing LVMI (MD= –11.54, 95%CI –15.06 to –8.01), IVST (MD= –0.76, 95%CI –1.25 to –0.27) and LVPWT (MD= –0.80, 95%CI –1.01 to –0.59). But clinical effectiveness was similar between the combination group and the CCBs group or the ACEIs group in aspects of the left ventricular end diastolic diameter (LVEDD), fraction shortening (FS) and ejection fractions (EF) (Pgt;0.05). Conclusion The combination therapy of CCBs with ACEIs is superior to either the CCBs or the ACEIsmonothrepy in regression of left ventricular hypertrophy. Because of the low methodological quality and small sample, this conclusion needs to be proved by more high-quality, large-scale and multicenter randomized controlled trials in the future.
Objective To estimate the efficacy and tolerability of combination of Amlodipine and different angiotensin-converting enzyme inhibitors (ACEIs) in comparison with Amlodipine monotherapy in the treatment of hypertension. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), PubMed, MEDLINE, EMbase, CBM, and CNKI (from their inception to August 2009) for relevant studies. Two reviewers independently retrieved randomized controlled trials (RCTs) according to the inclusion and exclusion criteria, assessed the methodological quality of included trials, and extracted data. Meta-analysis was performed by Stata 10.0 soft. Results Seventeen RCTs involving 3 291 patients were ultimately identified. The results of meta-analyses showed combination had a greater systolic blood pressure reduction (WMD=5.72, 95%CI 4.10 to 7.33, P=0.016) and diastolic blood pressure reduction (WMD=3.62, 95%CI 4.85 to 2.39, P=0.000) than monotherapy. Combination had fewer overall adverse events (RR=0.86, 95% CI 0.75 to 0.99) than that of monotherapy. Conclusion The results of meta-analyses indicate that combination provides a superior blood pressure control to that of monotherapy and has fewer adverse events and better tolerability in hypertensive patients.
We correct some misunderstandings of hypertension therapy and update the knowledge of hypertensive drugs by reviewing the progress of evidence-based research of hypertension in 2004.
Objective To search evidence of angiotensin-converting-enzyme inhibitors for microalbumin-uria in type 2 diabetes for guiding clinical practice. Methods We searched MEDLINE （ 1970 -Jun. 2005 ） to identify randomized controlled trials （RCT）of the effect on angiotensin-converting-enzyme inhibitors to prevent microalbuminuria in type 2 diabetes. Results One RCT （n =1 204）was identified. The result showed that angiotensin-converting-enzyme inhibitors were significantly more effective in prevention of microalbuminuria than other medicines in type 2 diabetes. However, angiotensin-converting-enzyme inhibitors may increase the risk of cardiac mortality. We explained the evidence to patients and they were satisfied with our explanation. Conclusions Angiotensin-converting-enzyme inhibitors can decrease the incidence of microalbuminuria in patients with type 2 diabetes and hypertension.
ObjectivesTo systematically review the efficacy of different rennin-angiotensin system blockers in prevention of stroke recurrence and reduction of major vascular events in patients with prior stroke.MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of ACEIs and ARBs for stroke secondary prevention from inception to November 1st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using Stata 15.1 software.ResultsA total of 6 RCTs involving 25 620 patients were included. The results of network meta-analysis showed that: in prevention of stroke recurrence, candesartan (RR=0.40, 95%CI 0.16 to 0.99) and valsartan (RR=0.22, 95%CI 0.07 to 0.76) were significantly lower than placebo; valsartan was lower than telmisartan (RR=0.24, 95%CI 0.07 to 0.81), ramipril (RR=0.26, 95%CI 0.07 to 0.93) and perindopril (RR=0.23, 95%CI 0.07 to 0.81). For reducing the major vascular events after stroke, candesartan (RR=0.39, 95%CI 0.21 to 0.74), valsartan (RR=0.27, 95%CI 0.11 to 0.64) and ramipril (RR=0.76, 95%CI 0.60 to 0.95) were significantly lower than placebo; valsartan was lower than telmisartan (RR=0.29, 95%CI 0.12 to 0.69), ramipril (RR=0.36, 95%CI 0.15 to 0.88) and perindopril (RR=0.28, 95%CI 0.12 to 0.68); candesartan was lower than telmisartan (RR=0.42, 95%CI 0.22 to 0.79) and perindopril (RR=0.41, 95%CI 0.21 to 0.79).ConclusionsCurrent evidence shows that valsartan and candesartan can reduce the stroke recurrence and major vascular events after stroke. Ramipril can reduce the major vascular event in patients with prior stroke. Valsartan might be the best option in both outcomes. Due to limited quantity of the included studies, more high quality studies are required to verify above conclusions.