PP.13.18] LONG-TERM OUTCOMES IN THE TREATMENT IN HIPERTENSIVE PATIENTS WITH ANGIOTENSIN-CONVERTING ENZYME INHIBITORS OR RENIN-ANGIOTENSIN RECEPTOR BLOCKERS

Abstract

Objective: The ACEIs (Angiotensin-Converting-Enzyme Inhibitors) and ARBs (Angiotensin II Receptor Blocker AT-1) effectiveness’ in reducing the systemic hypertension (SH) is widely known. However their comparative outcomes resulting from prolonged use remain unknown. The objective of this study is to compare by a Meta-Analysis of prospective randomized double-blind clinical trials all the events results from prolonged use of ACEIs or ARBs in hypertensive patients. Design and method: Three reviewers, independently, made the selection in the following databases: PUBMED, LILACS and SCIELO. We used the combination of inclusion and exclusion criteria to select randomized double-blind clinical trials. After the final selection of trials the statistical analysis was made by the program Comprehensive Meta-Analysis®. Results: We retrieved 1,621 studies in the databases for analysis of titles, being selected 855 abstracts for analysis. Were allocated to analyze the content 75 of these, in the end, 17 studies and 73,761 patients were reviewed. The use of ACEIs when compared to the control group, proved to be significant in reducing total mortality (TM) (OR = 0.851, 95% CI [0.776 to 0.935], P = 0.001) and reduction in cardiovascular mortality (CVD) (OR = 0.775, 95% CI [0.669 to 0.872], P = 0.000). The ARBs’ therapy did not show reduction of TM (OR = 1.024, 95% CI [0.960 the 1,091], P = 0.471) and CVD (OR = 0.947, 95% CI [0.849 the 1,056], P = 0.324). For Acute Myocardial Infarction (AMI), cerebrovascular accident (stroke) and heart failure (HF)/Internment, the reductions were significant for both classes. Conclusions: To lowering blood pressure in addition, the use of ACE inhibitors or ARBs reduces, in long-term use, the risk of AMI, Stroke and IC/Internment. However, the use of ACEI's is effective in reducing TM and CVD, an outcome that was not observed with the use of ARBs. This fact is assumed to be related to the higher plasma concentration of bradykinin in the use of ACEIs, a well-known cardio-vascular-protective factor.