January 1, 1997Journal of Hypertension
Comparison of type 1 angiotensin II receptor blockers and angiotensin converting enzyme inhibitors in the treatment of hypertension
Key result
AT1 receptor blockers offer an alternative to ACE inhibitors for hypertension, avoiding the common side effect of cough, though their comparative clinical and renal benefits require further study.
Why the study?
Do AT1 receptor blockers offer different pharmacologic, metabolic, or side effect profiles compared to ACE inhibitors in patients with hypertension?
Population
Patients with hypertension and/or congestive heart failure
Comparison
AT1 receptor blockers (e.g., candesartan) vs Angiotensin converting enzyme inhibitors
Design
Review
Authors
Discussion
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Implication
May support ARBs as cough-free alternatives to ACE inhibitors; leaves open comparative clinical and renal benefits.
Key Points
- To compare the pharmacological mechanisms, therapeutic efficacy, metabolic effects, and tolerability profiles of ACE inhibitors and AT1 receptor blockers in the management of hypertension.
- Comparative pharmacological analysis evaluating the mechanisms of renin-angiotensin system inhibition between ACE inhibitors and selective AT1 receptor blockers.
- Evaluation of clinical and physiological endpoints, including blood pressure trough:peak ratios, glucose clearance and insulin sensitivity (M value), renal outcomes, and adverse-effect profiles.
- AT1 receptor blockers provide selective receptor inhibition while leaving growth-inhibitory AT2 receptors unaffected, whereas ACE inhibitors result in incomplete suppression of angiotensin II formation.
- Both the ACE inhibitor delapril and the AT1 blocker candesartan improve insulin sensitivity, with candesartan normalizing the reduced glucose clearance M value observed in essential hypertension.
- AT1 receptor blockers exhibit high trough:peak efficacy ratios and do not cause the persistent dry cough commonly associated with ACE inhibitor therapy.
Structured PICO
Do AT1 receptor blockers offer different pharmacologic, metabolic, or side effect profiles compared to ACE inhibitors in patients with hypertension?
P
Population
Patients with hypertension and/or congestive heart failure
I
Intervention
AT1 receptor blockers (e.g., candesartan)
C
Comparator
Angiotensin converting enzyme (ACE) inhibitors (e.g., delapril)
AT1 receptor blockers offer an effective alternative to ACE inhibitors for hypertension, notably avoiding the side effect of cough while potentially providing similar metabolic benefits.
Limitations
- Clinical relevance of differing pharmacologic properties not yet established
- Comparable renal data not yet available for AT1 blockers
- Future studies needed for metabolic and cardiovascular questions
Cite This Study
Michael A. Weber (1997) conducted a review in Hypertension. AT1 receptor blockers vs. ACE inhibitors was evaluated. AT1 receptor blockers offer an alternative to ACE inhibitors for hypertension, avoiding the common side effect of cough, though their comparative clinical and renal benefits require further study.