Summary of findings 4. First‐line angiotensin converting enzyme inhibitor compared to placebo for hypertension.
| First‐line angiotensin converting enzyme (ACE) inhibitor compared to placebo for hypertension | ||||||
| Patient or population: adult patients with primary hypertension Setting: outpatient Intervention: First‐line ACE inhibitor (mean duration 4.9 years) Comparison: placebo or untreated | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with Placebo |
Risk with ACE inhibitors |
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| Total mortality | 136 per 1000 | 113 per 1000 (98 to 129) | RR 0.83 (0.72 to 0.95) | 6002 (3 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ARR = 2.3%; NNTB = 43 Mostly secondary prevention population |
| Total stroke | 60 per 1000 | 39 per 1000 (31 to 49) | RR 0.65 (0.52 to 0.82) | 6002 (3 RCTs) | ⊕⊕⊝⊝ LOW 1,2 | ARR = 2.1%; NNTB = 48 Mostly secondary prevention population |
| Total coronary heart disease | 135 per 1000 | 110 per 1000 (95 to 127) | RR 0.81 (0.70 to 0.94) | 5145 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ARR = 2.5%; NNTB = 40 Mostly secondary prevention population |
| Total cardiovascular events | 201 per 1000 | 153 per 1000 (135 to 171) | RR 0.76 (0.67 to 0.85) | 5145 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ARR = 4.8%; NNTB = 21 Mostly secondary prevention population |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; RCT: randomized controlled trial; ARR: Absolute risk reduction; ARI: Absolute risk increase; NNTB: Number needed to treat for an additional beneficial outcome. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1. Downgraded due to high risk of attrition and other bias.
2. Downgraded due to imprecision (wide confidence interval).