ACE inhibitors beat ARBs hands-down for survival benefit.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are mainstays of treatment for heart failure. Both help the heart pump more effectively by affecting the renin-angiotensin-aldosterone system (RAAS), which governs blood pressure. So it seems strange that no specific comparison of their impact on death from high blood pressure (hypertension) has ever been performed until recently.
As reported in the April 17, 2012, European Heart Journal, researchers in the Netherlands analyzed 20 clinical trials involving 158,998 patients with a primary diagnosis of hypertension, who were being treated with ACE inhibitors, ARBs, and other RAAS inhibitors. Although little difference between ACE inhibitors and ARBs is seen in the treatment of heart failure, their impact on hypertension is vastly different. In this study, ACE inhibitors reduced death from all causes by 10%, while ARBs had a neutral effect on mortality.
The difference between the drugs is likely due to their different modes of action. ACE inhibitors interfere with the formation of angiotensin II, a hormone that constricts arteries and raises blood pressure. ARBs block angiotensin II from binding to and affecting blood vessels and organs.
The potential impact of more widespread prescribing is enormous. According to the authors of the study, treating high blood pressure with ACE inhibitors could save many lives.