Účinek inhibitorů ACE a AT1-blokátorů na pokles celkové mortality u pacientů s hypertenzí, diabetes mellitus a bez srdečního selhání

Title in English	Effects of ACE inhibitors and AT1-receptor blockers on the all-cause mortality in patients with hypertension, diabetes mellitus and without heart failure
Authors	SOUČEK Miroslav
Year of publication	2017
Type	Article in Periodical
Magazine / Source	Diabetologie - Metabolismus - Endokrinologie - Výživa
MU Faculty or unit	Faculty of Medicine
Citation
Field	Other specializations of internal medicine
Keywords	hypertension; diabetes mellitus; RAAS system; ACEI; AT1 R-blockers
Description	The renin angiotensin aldosterone system (RAAS) blockade is currently considered the gold standard in the treatment of hypertension. ACE inhibitors (ACEI) and AT1 R-blockers (sartans) represent the most clinically relevant drug groups of RAAS blockers. Although both groups block angiotensin II pathway, ACEI additionally decreases the degradation of bradykinin which leads to increase in the production of nitric oxide and prostaglandins with the subsequent vasodilation - these effects may be essential especially for hypertensive patients. In the meta-analysis of 20 morbidity-mortality studies with RAAS blockers, ACEI increased overall survival of hypertensive patients however, there were significant differences between individual drugs in their effects on all-cause mortality. Using perindopril statistically significantly decreased the all-cause mortality by 13 % however other ACEI did not show this effect. Moreover, there were no differences between individual AT1 R-blockers.The same results were obtained in the meta-analysis in patients with hypertension and diabetes mellitus. In 2016, Bangalore et al. published results of the meta-analysis of randomized placebo controlled studies, studies with active comparator and studies directly comparing sartans and ACEl in patients without heart failure and their study shows that the cardioprotective effect of sartans is comparable to that of ACEI.