rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2013-9-4-427-432rpcardio-108Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯANGIOTENSIN CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS: IS THERE A REASON TO CONSIDER AN EQUIVALENCE OF TWO DRUG CLASSES FROM THE EVIDENCE BASED MEDICINE STANDPOINTИНГИБИТОРЫ АНГИОТЕНЗИНПРЕВРАЩАЮЩЕГО ФЕРМЕНТА И АНТАГОНИСТЫ РЕЦЕПТОРОВ АНГИОТЕНЗИНА: ЕСТЬ ЛИ ОСНОВАНИЯ ГОВОРИТЬ О РАВЕНСТВЕ ДВУХ КЛАССОВ ПРЕПАРАТОВ С ПОЗИЦИЙ ДОКАЗАТЕЛЬНОЙ МЕДИЦИНЫМарцевичС. Ю.MartsevichS. Yu.

Доктор медицинских наук, профессор, руководитель отдела профилактической фармакотерапии

smartsevich@gnicpm.ruГосударственный научно-исследовательский центр профилактической медицины, МоскваРоссияState Research Centre for Preventive Medicine, MoscowRussian Federation20132209201594427432Copyright © Martsevich S.Y., 20152015Марцевич С.Ю.Martsevich S.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/108

The results of the main large controlled trials that had proven effect of ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) on cardiovascular diseases outcomes are evaluated. Data of the recent meta-analyzes comparing ACEi and ARB effects on the life prognosis in patients of the high cardiovascular risk are presented. Better validity of ACEi efficacy versus this of ARB is concluded.

Оценивает результаты основных крупных контролируемых исследований, доказавших влияние ингибиторов  АПФ (ИАПФ) и антагонистов рецепторов ангиотензина (АРА) на исходы сердечно-сосудистых заболеваний. Приводит данные последних мета-анализов, сравнивающих влияние ИАПФ и АРА на прогноз жизни больных с высоким сердечно-сосудистым риском. Делает заключение о более доказанной эффективности ИАПФ в сравнении с АРА.

ингибиторы ангиотензинпревращающего ферментаантагонисты рецепторов ангиотензинаотдаленные результаты леченияangiotensin converting enzyme inhibitorsangiotensin receptor blockerslong-term outcomesReferencesAyman D. An evaluation of therapeutic results in essential hypertension. JAMA 1930; 95: 246-9.Ayman D. An evaluation of therapeutic results in essential hypertension. JAMA 1930; 95: 246-9.The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med 1987;316:1429-35.The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med 1987;316:1429-35.The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:292-302.The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:292-302.Pfeffer MA, Braunwald E, Moye LA, et al.; for the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction and myocardial infarction: results of the Survival and Ventricular Enlargement Trial. N Engl J Med 1992; 327:669-77.Pfeffer MA, Braunwald E, Moye LA, et al.; for the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction and myocardial infarction: results of the Survival and Ventricular Enlargement Trial. N Engl J Med 1992; 327:669-77.Acute Infarction Ramipril Efficacy (AIRE) Investigators. Effects of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821-8.Acute Infarction Ramipril Efficacy (AIRE) Investigators. Effects of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821-8.Kober L, Torp-Pedersen C, Carlsen JE, et al, for the Trandolapril Cardiac Evaluation (TRACE) Study Group. A clinical trial of the angiotensin-converting enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1995; 333: 1670-76.Kober L, Torp-Pedersen C, Carlsen JE, et al, for the Trandolapril Cardiac Evaluation (TRACE) Study Group. A clinical trial of the angiotensin-converting enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1995; 333: 1670-76.The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342:145-53.The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342:145-53.Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MI- CRO-HOPE substudy. Lancet 2000;355:253-9.Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MI- CRO-HOPE substudy. Lancet 2000;355:253-9.Fox KM, EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003;362:782-8.Fox KM, EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003;362:782-8.Pitt B, O’Neill B, Feldman R, et al. The QUinapril Ischemic Event Trial (QUIET): evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol 2001;87:1058-63.Pitt B, O’Neill B, Feldman R, et al. The QUinapril Ischemic Event Trial (QUIET): evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol 2001;87:1058-63.Braunwald E, Domanski MJ, Fowler SE, et al. Angiotensin converting-enzyme inhibition in stable coronary artery disease. PEACE Trial Investigators. N Engl J Med 2004;351:2058-2068.Braunwald E, Domanski MJ, Fowler SE, et al. Angiotensin converting-enzyme inhibition in stable coronary artery disease. PEACE Trial Investigators. N Engl J Med 2004;351:2058-2068.PROGRESS Collaborative Group. Randomised trial of a perindoprilbased bloodpressurelowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:103341.PROGRESS Collaborative Group. Randomised trial of a perindoprilbased bloodpressurelowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:103341.Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007;370:829-40.Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007;370:829-40.Pitt B, Segal R, Martinez FA, et al on behalf of the ELITE Study Investigators. Randomised trial of losartan versus captopril in patients over 65 with heart failure. Lancet 1997; 349: 747-752.Pitt B, Segal R, Martinez FA, et al on behalf of the ELITE Study Investigators. Randomised trial of losartan versus captopril in patients over 65 with heart failure. Lancet 1997; 349: 747-752.Pitt B, Poole-Wilson P, Segal R, et al on behalf of the ELITE II Study Investigators. Effects of losartan versus captopril on mortality in patients with symptomatic heart failure: rationale, design, and base- line charactertistics of patients in the losartan heart failure survival study ELITE II. J Card Fail 1999; 5 :146-54.Pitt B, Poole-Wilson P, Segal R, et al on behalf of the ELITE II Study Investigators. Effects of losartan versus captopril on mortality in patients with symptomatic heart failure: rationale, design, and base- line charactertistics of patients in the losartan heart failure survival study ELITE II. J Card Fail 1999; 5 :146-54.Dickstein K, Kjekshus J, for the OPTIMAAL Study Group. Comparison of the effects of losartan and captopril on mortality in patients after acute myocardial infarction: the OPTIMAAL trial design—Optimal Therapy in Myocardial Infarction with the Angiotensin II Antagonist Losartan. Am J Cardiol 1999; 83: 477-81.Dickstein K, Kjekshus J, for the OPTIMAAL Study Group. Comparison of the effects of losartan and captopril on mortality in patients after acute myocardial infarction: the OPTIMAAL trial design—Optimal Therapy in Myocardial Infarction with the Angiotensin II Antagonist Losartan. Am J Cardiol 1999; 83: 477-81.Dickstein K, Kjekshus J, and the OPTIMAAL Steering Committee for the OPTIMAAL Study Group. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet 2002: 360: 752-60.Dickstein K, Kjekshus J, and the OPTIMAAL Steering Committee for the OPTIMAAL Study Group. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet 2002: 360: 752-60.Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893-906.Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893-906.ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008;358:1547-59.ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008;358:1547-59.Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRAN- SCEND) Investigators, Yusuf S, Teo K, et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet 2008;372:1174-83.Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRAN- SCEND) Investigators, Yusuf S, Teo K, et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet 2008;372:1174-83.Granger C, McMarray J, Yusuf S, et al., for the CHARM Investigators and Committees. Effects of can- desartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 2003; 362: 772-6.Granger C, McMarray J, Yusuf S, et al., for the CHARM Investigators and Committees. Effects of can- desartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 2003; 362: 772-6.Schrader J, Luders S, Kulschewski A, et al. Morbidity and Mortality After Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005;36:1218-26.Schrader J, Luders S, Kulschewski A, et al. Morbidity and Mortality After Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005;36:1218-26.Yusuf S, Diener HC, Sacco RL, et al., for the PRoFESS Study Group. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med 2008;359:1225-1237.Yusuf S, Diener HC, Sacco RL, et al., for the PRoFESS Study Group. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med 2008;359:1225-1237.Lindholm LH, Ibsen H, Dahlof B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359:1004-10.Lindholm LH, Ibsen H, Dahlof B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359:1004-10.Lewise E, Hunsicker L, Clarke W, et al., For the Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan ib patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851-60.Lewise E, Hunsicker L, Clarke W, et al., For the Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan ib patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851-60.Brenner BM, Cooper ME, De Zeeuw D, et al., for the RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Eng J Med 2001;345:861-9.Brenner BM, Cooper ME, De Zeeuw D, et al., for the RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Eng J Med 2001;345:861-9.Massie B, Carson P, McMurray J. Irbesartan in patients with heart failure and preserves ejection frac- tion. N Engl J Med 2008; 359: 2456-67.Massie B, Carson P, McMurray J. Irbesartan in patients with heart failure and preserves ejection frac- tion. N Engl J Med 2008; 359: 2456-67.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003;362:7777-81.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003;362:7777-81.Cleland JG, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 2006;27:2338-45.Cleland JG, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 2006;27:2338-45.Sandset EC, Bath PM, Boysen G, et al., the SCAST Study Group. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, plcebo-controlled, double-blind trial. Lancet 2011; 377:741-50.Sandset EC, Bath PM, Boysen G, et al., the SCAST Study Group. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, plcebo-controlled, double-blind trial. Lancet 2011; 377:741-50.Haller H, Viberti GC, Mimran A, et al. Preventing microalbuminuria in patients with diabetes: rationale and design of the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study. J Hypertens 2006;24:403-8.Haller H, Viberti GC, Mimran A, et al. Preventing microalbuminuria in patients with diabetes: rationale and design of the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study. J Hypertens 2006;24:403-8.NAVIGATOR Study Group. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 2010;362:1477-90.NAVIGATOR Study Group. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 2010;362:1477-90.Van Vark L, Bertrand M, Akkerhuis M, et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158 988 patients. Eur Hear J 2012; 33: 2088-97.Van Vark L, Bertrand M, Akkerhuis M, et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158 988 patients. Eur Hear J 2012; 33: 2088-97.Savarese G, Costanzo P, Cleland J, et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Car- diol 2013; 61: 131-42.Savarese G, Costanzo P, Cleland J, et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Car- diol 2013; 61: 131-42.

The authors declare that there are no conflicts of interest present.