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Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension: AHRQ Executive Summary

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Target Audience and Goal Statement

This article is intended for primary care clinicians, pharmacists, cardiologists, nurses, and other specialists who care for patients with hypertension.

The goal of this activity is to teach the latest Effectiveness Report comparative data on angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension.

Upon completion of this activity, participants will be able to:

  1. Determine whether angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) differ in outcomes, quality of life, or treatment rates in adult patients with essential hypertension
  2. Identify any significant differences in adverse effects between ACEIs and ARBs
  3. Discuss whether there are any subgroups of patients who might tolerate one class of these antihypertensives over the other


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Author(s)

  • Agency for Healthcare Research and Quality

    Disclosures

    Disclosure: 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.

Editor(s)

  • Carol Peckham

    Director, Editorial Development, Medscape, LLC

    Disclosures

    Disclosure: Carol Peckham has disclosed no relevant financial relationships.


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CME/CE

Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension: AHRQ Executive Summary: Conclusions

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Conclusions

Summary Table 1 provides an aggregated view of the strength of evidence and brief conclusions from this review of the comparative long-term benefits and harms of ACEIs vs. ARBs for adults with essential hypertension. Tables 2-5 provide characteristics and pricing for specific ACEIs and ARBs.

Table 1. Evidence on Comparative Long-term Benefits and Harms of ACEIs vs. ARBs for Essential Hypertension

Key Question Strength of evidence Conclusions
1. Key Question 1. For adult patients with essential hypertension, how do ACEIs and ARBs differ in the following health outcomes:
a. Blood pressure control High ACEIs and ARBs appear to have similar long-term effects on blood pressure among individuals with essential hypertension. This conclusion is based on evidence from 50 studies (47 RCTs, 1 nonrandomized controlled clinical trial, 1 retrospective cohort study, and 1 case-control study) in which 13,532 patients receiving an ACEI or an ARB were followed for periods from 12 weeks to 5 years (median 16.5 weeks). Blood pressure outcomes were confounded by additional treatments and varying dose escalation protocols.
b. Mortality and major cardiovascular events Moderate Due to insufficient numbers of deaths or major cardiovascular events in the included studies, it was not possible to discern any differential effect of ACEIs vs. ARBs for these critical outcomes. In 9 studies that reported mortality, MI, or clinical stroke as outcomes among 3,356 subjects, 16 deaths and 13 strokes were reported. This may reflect low event rates among otherwise healthy patients and relatively few studies with extended followup.
c. Quality of life Low No differences were found in measures of general quality of life; this is based on 4 studies, 2 of which did not provide quantitative data.
d. Rate of use of a single antihypertensive High There was no statistically evident difference in the rate of treatment success based on use of a single antihypertensive for ARBs compared to ACEIs. The trend toward less frequent addition of a second agent to an ARB was heavily influenced by retrospective cohort studies, where medication discontinuation rates were higher in ACEI-treated patients, and by RCTs with very loosely defined protocols for medication titration and switching.
e. Risk factor reduction and other intermediate outcomes Moderate (lipid levels, markers of carbohydrate metabolism/diabetes control, progression of renal disease) to Low (progression to type 2 diabetes and LV mass/function) There were no consistent differential effects of ACEIs vs. ARBs on several potentially important clinical outcomes, including lipid levels, progression to type 2 diabetes mellitus, markers of carbohydrate metabolism/diabetes control, measures of LV mass or function, and progression of renal disease (either based on creatinine, GFR, or proteinuria). Relatively few studies assessed these outcomes over the long term.
2. Key Question 2. For adult patients with essential hypertension, how do ACEIs and ARBs differ in safety, adverse events, tolerability, persistence, and adherence? High (cough, withdrawals due to adverse events) to Moderate (persistence/adherence) to Low (angioedema) ACEIs have been consistently shown to be associated with greater risk of cough than ARBs: pooled odds ratio (Peto) = 0.32. For RCTs, this translates to a difference in rates of cough of 6.7 percent (NNT = 15); however, for cohort studies with lower rates of cough, this translates to a difference of 1.1 percent (NNT = 87). This is generally consistent with evidence reviewed regarding withdrawals due to adverse events, in which the NNT is on the order of 27 -- that is, 1 more withdrawal per 27 patients treated with an ACEI vs. an ARB. There was no evidence of differences in rates of other commonly reported specific adverse events.

Angioedema was reported only in patients treated with ACEIs; however, because angioedema was rarely explicitly reported in the included studies, it was not possible to estimate its frequency in this population.

ACEIs and ARBs have similar rates of adherence based on pill counts; this result may not be applicable outside the clinical trial setting. Rates of continuation with therapy appear to be somewhat better with ARBs than with ACEIs; however, due to variability in definitions, limitations inherent in longitudinal cohort studies, and relatively small sample sizes for ARBs, the precise magnitude of this effect is difficult to quantify.
3. 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? Very low Evidence does not support conclusions regarding the comparative effectiveness, adverse events, or tolerability of ACEIs and ARBs for any particular patient subgroup.
Abbreviations: ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin II receptor blocker/antagonist; GFR = glomerular filtration rate; LV = left ventricular; MI = myocardial infarction; NNT = number needed to treat; RCT = randomized controlled trial.

Table 2. Characteristics and Labeled Indications of Angiotensin-converting Enzyme Inhibitor(s) (ACEIs) Evaluated in This Report

Drug (trade name) Half-life and other relevant pharmacokinetic features Labeled indications Dosing for treatment of hypertension Dose adjustments for special populations
Benazepril (Lotensin) After oral administration, peak plasma concentrations reached within 0.5-1 hr.

Effective half-life in adults following multiple dosing 10-12 hr.

Cleared predominantly by renal excretion in subjects with normal renal function.
Treatment of hypertension. May be used alone or in combination with thiazide diuretics. Initial dose for adults not receiving a diuretic is 10 mg once daily. Usual maintenance range is 20-40 mg per day in a single or two equal doses. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

In patients with renal insufficiency (creatinine clearance ≤ 30 mL/min/1.73 m²) peak levels and initial half-life increase, time to steady state may be delayed. Recommended initial dose in such patients is 5 mg once daily. Dosage may be titrated upward until BP is controlled or to a maximum total daily dose of 40 mg.
Captopril (Capoten) After oral administration, peak plasma concentrations reached in 1 hr. Presence of food reduces absorption by 30-40%.

In adults, effective half-life < 3 hr (accurate determination of half-life not possible).

In a 24-hr period, 95% of observed dose eliminated in the urine.

Reduction of BP maximum at 60-90 minutes after oral administration, duration of effect dose-related.

Reduction in BP may be progressive.
1. Treatment of hypertension.

2. Treatment of congestive heart failure.

3. To improve survival following MI in clinically stable patients.
Should be taken 1 hr before meals, dosage must be individualized. Initial dose is 25 mg twice per day or three times per day. Dosage may be increased to 50 mg twice per day or three times per day. Usual dose range is 25-150 mg twice per day or three times per day. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Patients with renal impairment: initial daily dose should be reduced, smaller increments should be utilized for titration, and minimal effective dose should be calculated.
Enalapril (Vasotec) After oral administration, peak serum concentrations occur within 1 hr.

Primarily renal, 94% of dose is recovered in the urine and feces.

Effective half-life following multiple doses is 11 hr.

With GFR ≤ 30 mL/min, time to peak concentration.
Treatment of hypertension. 10-40 mg per day in a single or two divided doses. Daily dose should not exceed 50 mg. Dosage reduction and/or discontinuation may be required for some patients who develop increases in blood urea and serum creatinine. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus. Enalapril has been detected in human breast milk.

Dose selection for elderly patients should be cautious, usually starting at the low end of the dosing range.
Fosinopril (Monopril) fter oral administration, peak concentrations achieved in 3 hr.

Terminal elimination half-life is 12 hr.

Cleared predominantly by renal excretion in subjects with normal renal function.
1. Treatment of hypertension. May be used alone or with thiazide diuretics.

2. For heart failure as adjunctive therapy when added to conventional therapy, including diuretics with or without digitalis.
Initial dosage is 10 mg once daily, both as monotherapy and when the drug is added to a diuretic. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

In children, doses between 0.1 and 0.6 mg/kg. For children weighing more then 50 kg, dosage is 5-10 mg once daily.

For heart failure patients, an initial dose of 5 mg can be increased over a several-week period but not exceeding 40 mg once daily.
Lisinopril (Prinivil; Zestril) Reaches peak serum concentrations within 7 hr. On multiple doses, effective half-life accumulation is 12 hr.

Excreted primarily through the kidneys.
1. Treatment of hypertension.

2. As adjunctive therapy in the management of heart failure not responding to diuretics and digitalis.

3. Acute MI -- for the treatment of hemodynamically stable patients, to improve survival.
Initial dose is 10 mg once daily, usual dose range 20-40 mg daily in a single dose. Patients on a diuretic dosage should be adjusted according to BP response, and the diuretic should ideally be discontinued. For patients with creatinine clearance ≤ 10 mL/min, recommended initial dose is 2.5 mg, can be titrated upward up to a maximum of 40 mg daily. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Dose selection for elderly patients should start at the low end of dosing range.
Moexipril (Univasc) Bioavailability of oral drug is 13% compared to IV; markedly affected by food.

After oral administration, 7% appears in urine (vs. 40% of IV dose), 52% in feces (vs. 20% of IV dose).
Treatment of hypertension. Initial dose in patients not receiving diuretics is 7.5 mg 1 hr prior to meals, once daily. Recommended dose range is 7.5-30 mg daily in one or two divided doses. Diuretic therapy should ideally be discontinued or an initial dose of 3.75 mg should be used with medical supervision. For patients with creatinine clearance ≤ 40 mL/min/1.73 m², the recommended initial dose is 3.75 mg once daily, can be titrated to a maximum daily dose of 15 mg. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Dosage should be adjusted for populations with decreased renal function, mild to moderate cirrhosis and in elderly patients.
Perindopril (Aceon) After oral administration, peak plasma concentrations occur at approximately 1 hr.

Mean half-life 0.8-1.0 hr.

Clearance almost exclusively renal.
1. Treatment of hypertension. May be used alone or in combination with thiazide diuretics.

2. Stable coronary artery disease: to reduce risk of cardiovascular mortality or nonfatal MI.
Initial dose is 4 mg once daily. May be titrated upward until BP is controlled to a maximum of 16 mg per day. Usual dose range is 4-8 mg as single daily dose. May be given in two divided doses. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Dose selection for elderly patients should start at the low end of dosing range.

Patients with renal impairment: initial daily dose should be reduced.
Quinapril (Accupril) After oral administration, peak plasma concentrations reached within 1 hr.

After multiple oral dosing, effective half-life within 2 hr.

Cleared predominantly by renal excretion in subjects with normal renal function.
1. Treatment of hypertension. May be used alone or with thiazide diuretics.

2. Management of heart failure as adjunctive therapy when added to conventional therapy, including diuretics and/or digitalis.
Initial dosage for patients not on diuretics is 10-20 mg once daily. Dosage adjusted according to BP measured at peak and trough. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Patients with renal impairment and heart failure: initial daily dose should be reduced.

Recommended dosage for elderly patients is 10 mg once daily followed
Ramipril (Altace) After oral administration, peak plasma concentrations reached within 1 hr.

Cleared predominantly by renal excretion in subjects with normal renal function.
1. Treatment of hypertension. May be used alone or in combination with thiazide diuretics.

2. Reduction in risk of MI, stroke, and death from cardiovascular causes for patients 55 years or older at high cardiovascular risk.
Initial dose for patients not receiving a diuretic is 2.5 mg once daily. Dosage adjustment according to BP response. Usual maintenance dosage is 2.5-20 mg once daily in a single dose or divided equally into 2 doses. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Patients with renal impairment: initial daily dose should be reduced, smaller increments should be utilized for titration and minimal effective dose should be calculated.
Trandolapril (Mavik) After oral administration under fasting conditions, peak concentrations occur within 1 hr.

Effective half-life approximately 6 hr.

Cleared predominantly by renal excretion in subjects with normal renal function.
1. Treatment of hypertension. May be used alone or with other antihypertensive medication.

2. Heart failure post-MI or LV dysfunction post-MI. Used to decrease risk of death and heart failure-related hospitalization.
Initial dosage in patients not receiving a diuretic is 1 mg once daily in patients who are not black and 2 mg in black patients. Dosage adjusted according to BP. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Patients with renal impairment: initial daily dose should be reduced, smaller increments should be utilized for titration and minimal effective dose should be calculated.

Table 3. Characteristics and Labeled Indications of Angiotensin II Receptor Antagonist(s) (ARBs) Evaluated in This Report

Drug (trade name) Half-life and other relevant pharmacokinetic features Labeled indications Dosing for treatment of hypertension Dose adjustments for special populations
Candesartan cilexetil (Atacand) After oral administration, peak serum concentrations reached after 3-4 hr.

Elimination of half-life occurs within 9 hr.

Excreted in urine and feces.
1. Treatment of hypertension. May be used alone or in combination with other antihypertensive agents.

2. Heart failure: used in patients with LV systolic dysfunction to reduce risk of death and heart failure.
Initial dose is 16 mg once daily. Can be given once or twice daily with doses ranging from 8-32 mg. Effect is usually present within 2 weeks, and maximal BP reduction occurs within 4-6 weeks. When used in pregnancy during the second and third trimesters, ACEIs can cause injury and even death to the developing fetus.

Lower dose for patients with moderate hepatic impairment or depletion of intravascular volume.
Eprosartan (Teveten) After oral administration, plasma concentrations peak around 1-2 hr in the fasted state.

Mean terminal elimination half-life following multiple doses of 600 mg was 20 hr.

Eliminated primarily by biliary and renal excretion.
Treatment of hypertension. May be used alone or in combination with other antihypertensives, such as diuretics and calcium channel blockers. Initial dose is 600 mg once daily. Can be given once or twice daily with doses ranging 400 mg to 800 mg. When used in pregnancy during the second and third trimesters, drugs that act directly on the renninangiotensin system can cause injury and even death to the developing fetus.

Elderly, hepatically impaired, or renally impaired patients should not exceed 600 mg daily.
Irbesartan (Avapro) After oral administration, peak plasma concentrations reached at 1.5-2 hr.

Average terminal elimination of half-life is 11-15 hr.

Eliminated primarily by biliary and renal excretion.
1. Treatment of hypertension. May be used alone or with other antihypertensive agents.

2. Nephropathy in type 2 diabetic patients. Indicated for treatment of patients with an elevated serum creatinine and proteinuria > 300 mg/day). Reduces rate of progression of nephropathy.
Initial dose is 150 mg once daily. Patients who require more reduction in BP should be titrated to 300 mg once daily. When used in pregnancy during the second and third trimesters, drugs that act directly on the renninangiotensin system can cause injury and even death to the developing fetus.

Nephropathy in type 2 diabetic patients: maintenance dose is 300 mg once daily.

Children (6-12 years): initial dose of 75 mg, up to 150 mg once daily. Ages 13-16: initial 150 mg once daily, can be titrated to 300 mg once daily, higher doses not recommended.

Lower initial dose for patients with depletion of intravascular volume or salt.
Losartan (Cozaar) After oral administration, mean peak concentrations reached in 1 hr.

Terminal half-life is 2 hr.

Eliminated primarily by biliary and renal excretion.
1. Treatment of hypertension. May be used alone or with other antihypertensive agents, including diuretics.

2. Hypertensive patients with LV hypertrophy: reduces risk of stroke, though some evidence that this does not apply to black patients.

3. Nephropathy in type 2 diabetic patients: reduces rate of progression of nephropathy as measured by doubling of serum creatinine or end-stage renal disease.
Initial dose is 50 mg once daily, with 25 mg used in patients with possible depletion of intravascular volume and patients with history of hepatic impairment. May be given twice daily with total doses from 25 mg to 100 mg. When used in pregnancy during the second and third trimesters, drugs that act directly on the renninangiotensin system can cause injury and even death to the developing fetus.

Pediatric hypertensive patients (6 years and greater): starting dose is 0.7 mg/kg once daily (up to 50 mg total) given as tablet or a suspension.

Hypertensive patients with LV hypertrophy: starting dose is 50 mg once daily. Based on BP response, hydrochlorothiazide 12.5 mg daily should be added and/or dose of losartan should be increased to 100 mg once daily followed by an increase of hydrochlorothiazide to 25 mg once daily.
Olmesartan medoxomil (Benicar) After oral administration, peak plasma concentrations reached after 1-2 hr.

Terminal elimination of half-life is 13 hr.

Eliminated primarily by biliary and renal excretion.
Treatment of hypertension. May be used alone or with other antihypertensive agents. Initial dose is 20 mg once daily. For patients requiring further reduction in BP, dose may be increased to 40 mg. When used in pregnancy during the second and third trimesters, drugs that act directly on the renninangiotensin system can cause injury and even death to the developing fetus.

In patients with impaired renal failure, a lower starting dose should be considered.
Telmisartan (Micardis) After oral administration, peak concentrations reached within 0.5-1 hr.

Terminal elimination of half-life is 24 hr.

Eliminated mostly through feces.
Treatment of hypertension. May be used alone or with other antihypertensive agents. Starting dose is 40 mg once daily. BP response is dose-related over range of 20-80 mg. When used in pregnancy during the second and third trimesters, drugs that act directly on the renninangiotensin system can cause injury and even death to the developing fetus.

Patients with depletion of intravascular volume, biliary obstructive disorders, or hepatic insufficiency should start treatment under close medical supervision.
Valsartan (Diovan) After oral administration, peak plasma concentrations reached within 2-4 hr.

Average elimination half-life about 6 hr.

Primarily eliminated in feces and urine.
1. Treatment of hypertension. May be used alone or with other antihypertensive agents.

2. Heart failure: used in treatment of heart failure, reduces hospitalizations.

3. Post-MI: used to reduce cardiovascular mortality.
Initial dose is 80 mg or 160 mg once daily in patients who are not volume depleted. May be used over a dose range of 80 mg to 320 mg once daily. When used in pregnancy during the second and third trimesters, drugs that act directly on the renninangiotensin system can cause injury and even death to the developing fetus.

Care should be given when dosing patients with hepatic or severe renal impairment.
Abbreviations: ACEI(s) = angiotensin-converting enzyme inhibitor(s); ARB(s) = angiotensin II receptor antagonist(s); BP = blood pressure; GFR = glomerular filtration rate; hr = hour(s); LV = left ventricular; MI = myocardial infarction

Table 4. Dose and Price of ACEIs

Drug Name Brand Name Dose for Hypertension1 Price for 1-Month Supply2
Generic Brand
Benazepril3 Lotensin 10
20
40
mg daily
mg daily
mg daily
$30
$30
$30
$45
$45
$45
Captopril Capoten 25
50
mg bid
mg bid
$40
$75
$115
$200
Enalapril Vasotec 5
10
20
20
mg daily
mg daily
mg daily
mg bid
$30
$30
$45
$90
$45
$45
$65
$135
Fosinopril Monopril 10 mg daily $35 $45
Lisinopril Prinivil, Zestril 10
20
40
mg daily
mg daily
mg daily
$30
$30
$45
$35
$40
$55
Moexipril3 Univasc 7.5
15
15
mg daily
mg daily
mg bid
NA $45
$50
$95
Perindopril Aceon 2
4
8
mg daily
mg daily
mg daily
NA $50
$55
$70
Quinapril Accupril 10
20
mg daily
mg daily
$35
$35
$45
$45
Ramipril Altace 2.5
5
10
mg daily
mg daily
mg daily
NA $50
$50
$60
Trandolapril Mavik 1
2
mg daily
mg daily
NA $40
$40
1Doses are representative of those used in the research studies.
2Average Wholesale Price from Drug Topics Redbook, 2007.
3This drug was not individually evaluated in comparative studies included in the review.
NA = not available as generic; bid = twice a day

Table 5. Dose and Price of ARBs

Drug Name Brand Name Dose for Hypertension1 Price for 1-Month Supply2
Generic Brand
Candasartan Atacand 4
8
16
mg daily
mg daily
mg daily
NA $55
$55
$55
Eprosartan Teveten 400
600
400
mg daily
mg daily
mg bid
NA $65
$75
$130
Irbesartan Avapro 150
300
mg daily
mg daily
NA $55
$70
Losartan Cozaar 25
50
100
mg daily
mg daily
mg daily
NA $55
$60
$80
Olmesartan3 Benicar 20
40
mg daily
mg daily
NA $50
$60
Telmisartan Micardis 20
40
80
mg daily
mg daily
mg daily
NA $50
$60
$65
Valsartan Diovan 80
160
mg daily
mg daily
NA $60
$65
1Doses are representative of those used in the research studies.
2Average Wholesale Price from Drug Topics Redbook, 2007.
3This drug was not individually evaluated in comparative studies included in the review.
NA = not available as generic; bid = twice a day

Remaining Issues

Despite the relative importance of both ACEIs and ARBs for treatment of essential hypertension, there is a paucity of comparative evidence for long-term benefits and harms of these two classes of agents. In particular, there is a lack of information about death or major cardiovascular events, and data on adverse events are inconsistently reported. Only nine studies compared ACEIs and ARBs for periods longer than 1 year.

Future Research

With the exception of rates of cough, the hypothesis that ACEIs and ARBs have clinically meaningful differences in long-term outcomes in individuals with essential hypertension is not strongly supported by the available evidence. Given the importance of these issues, it is notable how few large, long-term, head-to-head studies have been published. Further research in this area should consider:

  • Subgroups of special importance, such as individuals with essential hypertension and diabetes mellitus, congestive heart failure, chronic kidney disease, and dyslipidemia.

  • Pragmatic designs, such as clinical trials in which treatment is consistent with typical clinical practice, or randomization by organizationally meaningful clusters, such as practice organizations or health plans.

  • Outcomes over several years.

  • Outcomes measured according to current clinical standards.

  • Broader representation of groups such as the elderly and ethnic and racial minorities.

  • Evaluation of specific pairs of ACEIs and ARBs to allow differentiation within class.

Given the demonstrated higher incidence of cough with ACEIs, it would also be valuable to gain more precise understanding of the impact of cough on quality of life, care patterns (e.g., use of therapeutic agents for cough symptoms or conditions associated with cough), and health outcomes, particularly for individuals who continue to use ACEIs.

Full Report

This executive summary is part of the following document: 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.

For Print Copies

For print copies of Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension: Executive Summary No. 10 (AHRQ Pub. No. 08-EHC003-1), please call the AHRQ Clearinghouse at 1-800-358-9295 or e-mail [email protected].

Table of Contents

  1. Introduction
  2. Conclusions
  • Print