Hypertension
ARBs may offer survival advantage over ACE inhibitors
Study details: This multidatabase cohort study applied a target trial emulation framework to compare angiotensin-converting enzyme (ACE) inhibitors vs. angiotensin receptor blockers (ARBs) in newly treated adults from the UK Biobank (n=72,534) and China Renal Data System (n=255,806). Propensity score matching balanced baseline characteristics. Primary outcome was 5-year all-cause mortality; secondary outcome was major adverse cardiovascular events (MACE).
Results: Initiation of ACE inhibitors was associated with a higher cumulative incidence of 5-year all-cause mortality compared with ARBs (UK: 3.45% vs 3.04%, risk difference 0.42%, hazard ratio [HR], 1.13; China: risk difference 1.48%, HR, 1.12). Similarly, ACE inhibitor initiation was associated with increased risk of MACE in both cohorts.
Clinical impact: ARBs may confer superior long-term cardiovascular and survival benefits over ACE inhibitors. While both remain guideline-recommended, clinicians might consider ARBs preferentially, especially in patients at higher cardiovascular risk or those intolerant to ACE inhibitor side effects.
Source:
Xie C, et al. (2025, September 4). Hypertension. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors Versus Angiotensin Receptor Blockers: Multidatabase Target Trial Emulation Studies. https://pubmed.ncbi.nlm.nih.gov/40905143/