ACE Inhibitors and Angiotensin Receptor Blockers for the Prevention of Cardiovascular Outcomes: Recommendations from the 2024 Egyptian Cardiology Expert Consensus

was superior to atenolol ( a thiazide) by reducing stroke but not coronary events more effectively.Although initially marketed as being very different from ACE inhibitors, the ARBs were considered by many clinicians as ACE inhibitors without a cough.Since the beginning of this century, the superiority of ACE inhibitors or ARBs has been hotly debated.This debate included publications purporting to show that ARBs caused myocardial infarction [8] and others showing that ACE inhibitors and ARBs caused cancer [9,10].None of these findings now seem likely!For the last two decades renin-angiotensin system (RAS) blockers have for many become the cornerstone of antihypertensive therapy for most patients as more RCTs involving ACE inhibitors (e.g.ALLHAT [11], HOPE [12], ASCOT [13], PROGRESS [14]) and ARBs (e.g.VALUE [15], TRANSCEND [16], ROADMAP [17]) were delivered.Overall, the RCT data often appeared to favour ACE inhibitors over ARBs when like-forlike RCTs were compared (HOPE [12] vs TRAN-SCEND [16], ADVANCE [18] vs ROADMAP [17], PROGRESS [14] vs PROFESS [19]) but the only large head-to-head comparison, the , showed that the long-acting ARB telmisartan was overall equally effective at preventing CV events as the shorter-acting ACE inhibitor ramipril.It may be that the significantly greater 24-h BP reduction achieved by