Are renin-angiotensin system modulators effective in reducing cardiovascular mortality and morbidity solely due to their effect on blood pressure, or can their efficacy be attributed to additional benefits?

There was a general agreement that, although the primary goal remains effective blood pressure lowering, there must be other additional mechanisms responsible for the impressive efficacy of renin-angiotensin system modulators. Dr Meredith pointed out that STOP-Hypertension-2 showed a selective benefit associated with angiotensin converting enzyme (ACE) inhibitors in terms of incidence of myocardial infarction and frequency of heart failure.1 In addition, a review of data from the Glasgow blood pressure clinic reveals a benefit associated with ACE inhibitors which is independent of blood pressure lowering. However, if blood pressure is lowered sufficiently, the difference between treatments becomes less apparent.

Professor Swedberg acknowledged that ACE inhibitors and β blockers are doing more than was anticipated when they were …