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Cited by 460

The DOI matches its Crossref record; 17 of the 17 references it cites were found in a registry or an index.

Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158 998 patients

Open access
van Vark, L. C., Bertrand, M., Akkerhuis, K. M., Brugts, J. J., Fox, K., Mourad, J.-J., Boersma, E.·2012·European Heart Journal
DOI 10.1093/eurheartj/ehs075
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Abstract

AIMS: Renin-angiotensin-aldosterone system (RAAS) inhibitors are well established for the reduction in cardiovascular morbidity, but their impact on all-cause mortality in hypertensive patients is uncertain. Our objective was to analyse the effects of RAAS inhibitors as a class of drugs, as well as of angiotensin-converting enzyme (ACE) inhibitors and AT1 receptor blockers (ARBs) separately, on all-cause mortality. METHODS AND RESULTS: We performed a pooled analysis of 20 cardiovascular morbidity-mortality trials. In each trial at least two-thirds of the patients had to be diagnosed with hypertension, according to the trial-specific definition, and randomized to treatment with an RAAS inhibitor or control treatment. The cohort included 158 998 patients (71 401 RAAS inhibitor; 87 597 control). The incidence of all-cause death was 20.9 and 23.3 per 1000 patient-years in patients randomized to RAAS inhibition and controls, respectively. Overall, RAAS inhibition was associated with a 5% reduction in all-cause mortality (HR: 0.95, 95% CI: 0.91-1.00, P= 0.032), and a 7% reduction in cardiovascular mortality (HR: 0.93, 95% CI: 0.88-0.99, P= 0.018). The observed treatment effect resulted entirely from the class of ACE inhibitors, which were associated with a significant 10% reduction in all-cause mortality (HR: 0.90, 95% CI: 0.84-0.97, P= 0.004), whereas no mortality reduction could be demonstrated with ARB treatment (HR: 0.99, 95% CI: 0.94-1.04, P= 0.683). This difference in treatment effect between ACE inhibitors and ARBs on all-cause mortality was statistically significant (P-value for heterogeneity 0.036). CONCLUSION: In patients with hypertension, treatment with an ACE inhibitor results in a significant further reduction in all-cause mortality. Because of the high prevalence of hypertension, the widespread use of ACE inhibitors may result in an important gain in lives saved.

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Metadata

Authors
van Vark, L. C., Bertrand, M., Akkerhuis, K. M., Brugts, J. J., Fox, K., Mourad, J.-J., & Boersma, E.
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2012-04-17
Volume
33
Issue
16
Pages
2088-2097
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehs075
OpenAlex
W2119577709
Cited by
460
References
17
FWCI
9.52
Type
journal article
Language
en
Open access
hybrid

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CoChat. (2026). Citation check: Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158 998 patients. https://app.cochat.ai/papers/10.1093/eurheartj/ehs075
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van Vark, L. C., Bertrand, M., Akkerhuis, K. M., Brugts, J. J., Fox, K., Mourad, J.-J., & Boersma, E. (2012). Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158 998 patients. European Heart Journal. https://doi.org/10.1093/eurheartj/ehs075

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