What do systematic reviews say?

Renin inhibitors vs ACE inhibitor

Renin inhibitors showed no clear difference in all‐cause mortality compared with ACE inhibitors (low certainty).

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 1.05 [0.93, 1.18]
  5 studies · 5962 participants
  Low

Renin inhibitors vs ACE inhibitor

It is very uncertain whether renin inhibitors changes fatal or non‐fatal myocardial infarction compared with ACE inhibitors (very low certainty).

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 0.86 [0.22, 3.39]
  2 studies · 957 participants
  Very low

Renin inhibitors vs ACE inhibitor

Renin inhibitors showed no clear difference in adverse events compared with ACE inhibitors (moderate certainty).

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 0.98 [0.93, 1.03]
  10 studies · 6007 participants
  Moderate

Renin inhibitors vs ACE inhibitor

Renin inhibitors showed no clear difference in fatal or non‐fatal serious adverse events compared with ACE inhibitors (low certainty).

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 1.21 [0.89, 1.64]
  10 studies · 6007 participants
  Low

Renin inhibitors vs ACE inhibitor

Renin inhibitors showed no clear difference in withdrawal due to adverse effects (WDAE) compared with ACE inhibitors (low certainty).

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 0.85 [0.68, 1.06]
  10 studies · 6008 participants
  Low

Renin inhibitors vs ACE inhibitor

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  no estimate extracted
  9 studies · 5001 participants
  Low

Renin inhibitors vs ACE inhibitor

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  no estimate extracted
  9 studies · 5001 participants
  Low

RAS inhibitors vs CCBs

RAS inhibitors showed no clear difference in all‐cause death compared with CCBs (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 1.03 [0.98, 1.09]
  5 studies · 35226 participants
  Moderate

RAS inhibitors vs thiazides

RAS inhibitors showed no clear difference in total myocardial infarction compared with thiazides (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.93 [0.86, 1.01]
  2 studies · 24379 participants
  Moderate

RAS inhibitors vs thiazides

RAS inhibitors probably leads to higher total stroke compared with thiazides (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 1.14 [1.02, 1.28]
  1 study · 24309 participants
  Moderate

RAS inhibitors vs thiazides

RAS inhibitors showed no clear difference in end stage renal failure compared with thiazides (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 1.1 [0.88, 1.37]
  1 study · 24309 participants
  Low

RAS inhibitors vs beta‐blocker

RAS inhibitors showed no clear difference in all‐cause death compared with beta‐blockers (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.89 [0.78, 1.01]
  1 study · 9193 participants
  Low

RAS inhibitors vs beta‐blocker

RAS inhibitors may leads to lower total cardiovascular events compared with beta‐blockers (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.88 [0.8, 0.98]
  2 studies · 9239 participants
  Low

RAS inhibitors vs beta‐blocker

RAS inhibitors showed no clear difference in total heart failure compared with beta‐blockers (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.95 [0.76, 1.18]
  1 study · 9193 participants
  Low

RAS inhibitors vs beta‐blocker

RAS inhibitors showed no clear difference in total myocardial infarction compared with beta‐blockers (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 1.05 [0.86, 1.27]
  2 studies · 9239 participants
  Low

RAS inhibitors vs beta‐blocker

RAS inhibitors may leads to lower total stroke compared with beta‐blockers (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.75 [0.63, 0.88]
  1 study · 9193 participants
  Low

RAS inhibitors vs CCBs

RAS inhibitors showed no clear difference in total cardiovascular events compared with CCBs (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.98 [0.93, 1.02]
  6 studies · 35223 participants
  Moderate

RAS inhibitors vs CCBs

RAS inhibitors probably leads to lower death or hospitalization for heart failure compared with CCBs (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.83 [0.77, 0.9]
  5 studies · 35143 participants
  Moderate

RAS inhibitors vs CCBs

RAS inhibitors showed no clear difference in total myocardial infarction compared with CCBs (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 1.01 [0.93, 1.09]
  5 studies · 35043 participants
  Moderate

RAS inhibitors vs CCBs

RAS inhibitors probably leads to higher total stroke compared with CCBs (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 1.19 [1.08, 1.32]
  4 studies · 34673 participants
  Moderate