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July 10, 2000

Angiotensin II Receptor Blockers: Equal or Preferred Substitutes for ACE Inhibitors?

Arch Intern Med. 2000;160(13):1905-1911. doi:10.1001/archinte.160.13.1905

LONG-TERM studies with ACE inhibitors documenting efficacy in reducing cardiovascular morbidity and mortality in patients with hypertension are scarce.1-3 However, there is compelling evidence from prospective studies4,5 in patients with CHF and diabetic nephropathy that ACE inhibitors may be beneficial. Several prospective ongoing studies (Table 1) with ACE inhibitors and ARBs are ongoing, but the results of these studies will not be available for a few more years. Meanwhile, the practicing physician still faces the question: should ACE inhibitors or ARBs be preferred as a first-line therapy in hypertension? To answer this question, we will examine the evidence that has convinced the Joint National Committee VI6 and the World Health Organization–International Society of Hypertension (WHO-ISH) Committee7 to consider ACE inhibitors and ARBs as first-line therapies.

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