ACE Inhibitor or ARB for Initial Treatment of Hypertension?

Angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are considered equivalent for first-line treatment of patients with hypertension. ACE inhibitors have a longer track record and a larger body of randomized trial–level research on cardiovascular outcomes, but ARBs have fewer side effects. In this retrospective study of patients who initiated monotherapy for hypertension, researchers used eight large observational databases to compare outcomes for 2.3 million new users of ACE inhibitors and nearly 700,000 new users of ARBs.

Myocardial infarction, stroke, and heart failure occurred with similar frequency in the two groups, after extensive adjustment for demographic and clinical variables. However, cough, an…