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"hypertension"

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Clinical Questions Addressed by the CER (1 of 2)

Presentation: Analgesics for Osteoarthritis—An Update
Keywords: comparative effectiveness | systematic review | key question
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Comparative Adverse Effects of Oral Agents: CV Effects

Presentation: Analgesics for Osteoarthritis—An Update
Keywords: comparative adverse effects | outcomes | strength of evidence | NSAIDs | CV risk
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Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults with Hypertension

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
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Background: Prevalence

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: prevalence | hypertension | risk factor | heart | kidneys
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Background: Treatment

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: treatment | hypertension | diet | exercise | weight | antihypertensive medication
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Background: Pharmacological Blockade of the Renin-Angiotensin System

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: renin-angiotensin system | pharmacological blockade | angiotensinogen | angiotensin converting enzyme | angiotensin II
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Rationale for Update

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: systematic review | comparative effectiveness | ACEI | ARB | hypertension | aliskiren | DRI
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Evidence of Benefits: Clinical Outcomes

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: clinical outcomes | ACEIs | ARBs | mortality | cardiovascular events | serum lipid levels | renal disease | quality of life
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Gaps in Knowledge

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: gaps in knowledge | future research | subgroups | clinical trials
Applicability Resources. Clinical experts and stakeholders can provide general information important to framing applicability issues. What does the population of interest looks like? What types of care or procedures are routine or represent standard of care? Are certain subpopulations characteristically different from others?
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Applicability Resources

Presentation: Assessing Applicability
Keywords: Effective Health Care Program | comparative effectiveness review | stakeholder | population
Despite standard therapy, patients with stable ischemic heart disease and preserved left ventricular systolic function continue to be at risk for future cardiovascular events. The Renin-Angiotensin-Aldosterone System (RAAS) is critical for regulating blood pressure, electrolyte balance, and fluid volume homeostasis and plays a pivotal role in the pathogenesis of hypertension, congestive heart failure, and diabetic nephropathy. Pharmacological agonists of this system include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). These drugs block adverse effects of the RAAS by blocking the activity of angiotensin II. Through the stimulation of angiotensin II type-1 receptors, angiotensin II may have several potentially harmful activities including induction of aldosterone production, which can cause sodium retention and increased fluid retention that, in turn, leads to an increase in blood pressure, increased aldosterone production, which can possibly lead to promotion of pathogenic remodeling (i.e., atherosclerosis and fibrosis), constriction of blood vessels, which can lead to increased blood pressure, and potential reduction in the availability of nitric oxide through the production of free radicals and the induction of endothelial dysfunction that may impact endothelial wall integrity. ACEIs act on the RAAS by blocking the conversion of angiotensin I into angiotensin II and inhibiting the breakdown of bradykinin, which is a potent vasodilator. ARBs block the angiotensin II type-1 receptor and reduce the pharmacologic effects of angiotensin II, regardless of whether angiotensin II is created by the angiotensin-converting enzyme or by pathways that do not include this enzyme. ACEIs and ARBs may potentially provide several pharmacological effects over and above that of blood pressure reduction alone, which may impact cardiovascular events.
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Pharmacologic Effects of Antagonists on the Renin-Angiotensin-Aldosterone System

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: angiotensin II-receptor blocker | angiotensin-converting enzyme inhibitor | renin-angiotensin-aldosterone system | pharmacology
The decision to add an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to the standard treatment regimen for patients with stable ischemic heart disease (IHD) and preserved left ventricular systolic function should be considered on a case-by-case basis by both the attending physician and the patient. This chart summarizes the benefits and harms associated with therapies that include ACEIs, ARBs, or both. For a detailed analysis of the benefits of adding an ACEI or ARB to standard medical therapy, see the complete comparative effectiveness review available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=335. *In reviewing the benefits and harms listed in the table: An important point to consider is that while many of the trials included in these analyses reported harms data, adverse event reporting was not consistent across the trials. Additionally, several trials included a prerandomization run-in period, during which candidates who could not tolerate the trial drug were excluded. This may limit the applicability of the harms data to the entire IHD population. For specific details on trials that were evaluated, please refer to the original comparative effectiveness review, on which this slide talk is based (available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=334). Note: Angioedema, a rare but potentially serious reaction, has been reported in several trials. Patients who are or may become pregnant while taking an ACEI or an ARB should be made aware of the risk of birth defects caused by these drugs. This information is taken from the 2007 report, Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBS) for Treating Essential Hypertension, written by the Duke Evidence-Based Practice Center and funded by AHRQ. The report can be viewed at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=45&returnpage=.
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Identifying Trade-offs for Your Patients: Summary of Results on Comparative Effectiveness of Adding ACEIs and/or ARBs to Standard Medical Therapy

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: angiotensin II-receptor blocker | angiotensin-converting enzyme inhibitor | benefits | comparative effectiveness | harms | revascularization | stable ischemic heart disease | summary of results | identifying trade-offs
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