Authors: Manal E. Alotaibi , Roaa M. Alghamdi , Omar M. Khan , Yazan Shater , Abdullah Al-Aqla , Mohammed Al-Ahmadi , Ali Al-Harbi , Hassan Al-Hani , Mohammed Albagieh , Faris Al-Sahli

Abstract

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are primary treatments for essential hypertension. Direct comparisons of their efficacy in blood pressure control are limited. This systematic review and meta-analysis aimed to assess and compare the safety and efficacy of these drugs in adults with essential hypertension.

Methods: Randomized controlled trials (RCTs) published from 2015 to 2025 were systematically reviewed using PubMed, MEDLINE, and Scopus. Studies comparing ACEIs and ARBs in adults with essential hypertension, focusing on changes in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP), were included.

Results: Five RCTs including 852 participants were analyzed. There was no significant difference between ACEIs and ARBs in reducing SBP or achieving target blood pressure. The reduction in DBP was slightly greater with ACEIs. Safety profiles were similar; however, ACEIs were associated with a higher incidence of cough.

Conclusion: ACEIs and ARBs are equally effective in lowering SBP and managing blood pressure in adults with essential hypertension. Choice of therapy should be guided by tolerability, patient-specific factors, and vascular considerations rather than differences in blood pressure reduction.

Keywords: Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, essential hypertension, blood pressure lowering, antihypertensive therapy.