ACE Inhibitors versus Angiotensin Receptor Blockers for Cardiovascular Protection in Hypertension: A Meta-analysis of Major Cardiovascular Endpoints
Anuradha V Dave, Dr Rashmi Pandey, Ms Muskan Rastogi3
- Prof Community Medicine, SMC, Subharti University, Meerut (UP),2.Dr. Rashmi Pandey, Asstt Prof Biochemistry, GDMC Dehradun
(UK), 3. IIPH, Bhubaneswar, Orissa
*Corresponding Author: Prof Community Medicine, SMC, Subharti University, Meerut (UP); [email protected]
Submitted: 24 June 2026; Accepted: 2 July 2026; Published: 22 July 2026
Abstract: Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are both first-line agents for the pharmacological treatment of hypertension and are recommended interchangeably by most major guidelines. Despite acting on the same renin-angiotensin-aldosterone system (RAAS) pathway, these two drug classes are not pharmacologically identical,
and a body of trial and meta-analytic evidence has raised the question of whether they confer equivalent protection against hard cardiovascular endpoints —cardiovascular (CV) death, all-cause mortality, non-fatal stroke, and heart failure. This review summarizes the mechanistic rationale, synthesizes evidence from head-to-head and placebo-controlled trials, and situates the
findings within current hypertension guidelines to provide a practical framework for clinical decision-making.
