Treatment of Essential Hypertension with Emphasis in the Renin-Angiotensin System: How to Prevent Secondary Outcomes without Adding Fuel to the Fire

Abstract

The effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blocker AT-1 (ARBs) in reducing the systemic hypertension (SH) is widely known. However their comparative outcomes resulting from prolonged use remain unknown. The objective of this chapter is to discuss the evidence of prospective randomized double-blind clinical trials; all the events result from prolonged use of ACEIs or ARBs in hypertensive patients. In lowering blood pressure, the use of ACE inhibitors or ARBs reduces, in long-term use, the risk of acute myocardial infarction, stroke, and heart failure. However, the use of ACEIs is effective in an overall quantitative analysis; the total mortality regarding cardiovascular causes 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 cardiovascular-protective factor.