Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors Versus Angiotensin Receptor Blockers: Multidatabase Target Trial Emulation Studies

作者：Chao Xie, Ruixuan Chen, Shi-Yu Zhou, Yaduan Lin, Jiao Liu, Licong Su, Mingzhen Pang, Zhixin Guo, Fan Luo, L Y Chen, Yaozhong Kong, Sheng Nie · 发表于：Hypertension · 年份：2025 · DOI：10.1161/hypertensionaha.125.25549 · 被引用次数：8 · 研究领域：Blood Pressure and Hypertension Studies、Renin-Angiotensin System Studies、Heart Failure Treatment and Management

BACKGROUND: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are equally recommended as first-line treatment for cardiovascular and renal protection in clinical practice. Evidence on the comparative effectiveness of both drugs on long-term death is inconclusive. METHODS: This multidatabase cohort study used a target trial emulation framework based on the UK Biobank database and the China Renal Data System. Participants who were newly prescribed ACE inhibitors or ARBs were included. Primary and secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events, respectively. Propensity score matching was performed to balance the baseline characteristics. RESULTS: A total of 72 534 and 255 806 patients were identified from the UK Biobank database and the China Renal Data System database. After propensity score matching, cumulative incidence of 5-year all-cause mortality among patients with ACE inhibitor and ARB initiation was 3.45% (3.17%-3.74%) and 3.04% (2.76%-3.31%), with estimated risk differences and hazard ratios of 0.42% (95% CI, 0.02%-0.81%) and 1.13 (95% CI, 1.07-1.19) in the UK Biobank database. Consistent results were obtained in the China Renal Data System database (risk difference, 1.48% [95% CI, 1.10%-1.86%] and hazard ratio, 1.12 [95% CI, 1.09-1.14]). In addition, patients with ACE inhibitor initiation were associated with higher risk of major adverse cardiovascular events than those with ARB initiati...