ACEIs and ARBS: Should everybody with hypertension take them?
Since I became a general internist after a 17-year career in nephrology, I have utilized ACEIs and ARBs for myriad indications, including: hypertension, systolic heart failure, diabetic renal disease, chronic kidney disease (CKD), and for reductions in proteinuria. A recent article1 in Progress in Cardiovascular Diseases made me apply evidence-based medicine to my choice of ACEIs and ARBs, especially in hypertension without other compelling indications for ACEIs/ARBs, and in so doing, to question their universal superiority compared to other therapeutic agents.1
And now I turn that line of questioning over to you.
1. Of the following choices, which statements regarding ACEIs and ARBs are true?
A. Post-hoc analysis of the ALLHAT trial demonstrated that amlodipine, lisinopril, and chlorthalidone had similar efficacy in preventing cardiovascular events.1,2
B. In ALLHAT, lisinopril and chlorthalidone were comparable in preventing heart failure.1,2
C. In the SCOPE Trial, (elderly patients), when candesartan was compared to placebo for treatment of hypertension, there was no difference in the incidence of major cardiovascular events.1,3
D. In the Second Australian Blood Pressure (ANBP2) trial, (patients aged 65-84 years with hypertension) when ACEIs were compared to diuretics, ACEIs were superior in preventing cardiovascular events or deaths.4