Efficacy and safety of ACE inhibitors versus calcium channel blockers in the management of hypertension in adults: a systematic review

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Hypertension is a prevalent cardiovascular condition managed with various antihypertensive agents, including ACE inhibitors and calcium channel blockers. This study aimed to compare the effectiveness and safety of these two classes of medications in reducing blood pressure and achieving target blood pressure. A comprehensive literature search was conducted evaluating ACE inhibitors (e.g., Enalapril, Captopril, Lisinopril) and calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine) for hypertension management. The inclusion criteria were randomized controlled trials, observational studies, and comparative studies reporting on blood pressure reduction, achievement of target blood pressure, and adverse events. Data were extracted on study design, interventions, participant demographics, and outcomes. Study quality was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Calcium channel blockers generally showed superior efficacy in blood pressure reduction compared to ACE inhibitors. In terms of safety, ACE inhibitors were more frequently associated with cough and renal issues, while calcium channel blockers, particularly Amlodipine, were more prone to causing peripheral edema. Calcium channel blockers, especially Amlodipine, generally offer greater blood pressure reduction and a higher target achievement rate than ACE inhibitors. Despite the robust efficacy of ACE inhibitors like Enalapril, the overall safety profiles indicate that calcium channel blockers may provide a more effective approach for many patients. However, side effects such as peripheral edema need to be managed. This comparison underscores the need for individualized treatment strategies in hypertension management, considering both the effectiveness and side effect profiles of antihypertensive medications.