{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,21]],"date-time":"2025-06-21T23:21:59Z","timestamp":1750548119819},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,3,9]],"date-time":"2016-03-09T00:00:00Z","timestamp":1457481600000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:p>Previously, management of hypertension has concentrated on lowering elevated blood pressure. However, the target has shifted to reducing absolute cardiovascular (<jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content>) risk. It is estimated that two in three Australian adults have three or more <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> risk factors at the same time. Moderate reductions in several risk factors can, therefore, be more effective than major reductions in one. When managing hypertension, therapy should be focused on medications with the strongest evidence for <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> event reduction, substituting alternatives only when a primary choice is not appropriate. Hypertension management guidelines categorise angiotensin\u2010converting enzyme inhibitors (<jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content>) and angiotensin receptor blockers (<jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content>) interchangeably as first\u2010line treatments in uncomplicated hypertension. These medications have different mechanisms of action and quite different evidence bases. They are not interchangeable and their prescription should be based on clinical evidence. Despite this, currently <jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content> prescriptions are increasing at a higher rate than those for <jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content> and other antihypertensive classes. Evidence that <jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content> therapy prevents <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events and death, in patients with coronary artery disease or multiple <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> risk factors, emerged from the European trial on reduction of cardiac events with perindopril in stable coronary artery disease (<jats:styled-content style=\"fixed-case\">EUROPA<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">Heart Outcomes Prevention Evaluation (HOPE)<\/jats:styled-content> trials respectively. The consistent benefit has been demonstrated in meta\u2010analyses. The clinical trial data for <jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content> are less consistent, particularly regarding <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> outcomes and mortality benefit. The evidence supports the use of <jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content> (Class 1a) compared with <jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content> despite current prescribing trends.<\/jats:p>","DOI":"10.1111\/imj.12975","type":"journal-article","created":{"date-parts":[[2016,3,12]],"date-time":"2016-03-12T07:05:29Z","timestamp":1457766329000},"page":"364-372","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Cardiovascular risk reduction in hypertension: angiotensin\u2010converting enzyme inhibitors, angiotensin receptor blockers. 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