***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The CORD trials tested ramipril and losartan in patients with hypertension . PATIENTS AND METHODS CORD IA involving switching from an angiotensin-converting enzyme inhibitor ( ACEI ) to the angiotensin II receptor blocker ( ARB ) losartan .  4,016 patients with blood pressure ( BP ) < 160/100 mm Hg who had been treated with an ACEI for > 3 months were enrolled . The mean age was 62.6 + /- 11.6 years and 53.1 % were women . The patients discontinued ACEI and switched to losartan 50 mg once daily .  BP , heart rate , biochemistry , blood counts and ECGs were measured at day 1 and months 1 , 3 , 6 and 12 . If the BP was > or = 140/90 mm Hg after 1 month or more , the dose of losartan was increased to 100 mg . After 1 month the BP decreased from 147.4 + /- 14.8/87.7 + /- 9.3 mm Hg to 139.7 + /- 11.8/83.0 + /- 9.3 mm Hg ( p < 0.001 ) and after 1 year to 133.7 + /- 11.3/79.1 + /- 7.06 mm Hg ( p < 0.001 ) . The rate of adverse events did not significantly increase and no changes in plasma sodium , potassium , urea or creatinine were observed . CORD IB compared ramipril and losartan . 3,813 patients with BP > or = 140/90 mm Hg who were not being treated with an ACEI or ARB were enrolled . The mean age was 60.5 + /- 12.2 years and 50.5 % were women . The patients were r and omised to ramipril 5 mg ( n = 1,926 ) or losartan 50 mg ( n = 1,887 ) . The dose was doubled if BP after 1 month was > or = 140/90 mm Hg . If the BP after 3 months still was > or = 140/90 mm Hg , another antihypertensive drug was added , typically athiazide diuretic . RESULTS After 1 yearthe BP decreased in the ramipril group from 155.9 + /- 13.1/93.0 + /- 8.9 mm Hg to 134.1 + /- 11.2/81.5 + /- 6.8 mm Hg ( p < 0.001 ) and in the losartan group from 156.5 + /- 13.1/93.4 + /- 8.8 to 134.55 + /- 11.3/80.16 + /- 6.6 mm Hg ( p < 0.001 ) . No significant differences were found between the groups . A slight increase in plasma potassium ( 0.2 mmol in both groups ) and urea ( 0.3 mmol in both groups ) was observed , but no change in plasma creatinine . There was a small , insignificant decrease in plasma uric acid ( in the ramipril group from 325.5 to 320.7 micromol/l and in the losartan group from 321.6 to 318.3 micromol/l ) and a slight decrease in plasma glucose and triglycerides ( 0.2 mmol/l in both measures in both groups ) . No severe adverse events were observed , but dry cough was 8 times more frequently reported in the ramipril group . CONCLUSION CORD IA confirmed that switching from an ACEI to losartan is safe and effective . Titrating the dose upwards or adding diuretics leads to good BP control in the majority of patients ( 2/3 ) . CORD IB showed no differences between ramipril and losartan in lowering BP and both drugs showed a trend to improve metabolic parameters such as glycaemia , triglyceridaemia and uric acid equally . Dry cough was more frequent after ACEI Introduction . This subgroup analysis assessed the effects of treatment based on the direct renin inhibitor , aliskiren , or the angiotensin-converting enzyme inhibitor , ramipril , on plasma renin activity ( PRA ) , plasma renin concentration ( PRC ) and other biomarkers in a 26-week r and omised , double-blind trial . Changes in PRA and PRC after stopping treatment were also assessed . Methods . After placebo run-in , 842 patients ( mean sitting diastolic blood pressure ( BP ) 95—109 mmHg ) were r and omised to aliskiren 150 mg or ramipril  5 mg . Dose titration and hydrochlorothiazide addition were allowed after Week 6 and 12 , respectively , for inadequate BP control . Patients completing active treatment were re-r and omised to current regimen or placebo during a 4-week posttreatment phase . Results . BP reductions were independent of baseline PRA at Week 12 , were greater with aliskiren- than ramipril-based therapy at Week 26 ( 17.9/13.3 vs. 15.2/12.0 mmHg , p<0.05 ) and persisted for longer after stopping aliskiren . Aliskiren-based therapy  reduced geometric mean PRA ( −63 % , p<0.05 ; n=103 ) , while ramipril-based therapy  increased PRA ( + 143 % , p<0.05 ; n=100 ) at Week 26 ; PRC increased in both groups ( aliskiren : + 224 % [ n=33 ] , ramipril : + 145 % [ n=39 ] , both p<0.05 ) . Four weeks after stopping aliskiren-based therapy , PRA remained 52 % below pre-treatment baseline ; PRA returned to baseline 2 weeks after stopping ramipril-based therapy . Conclusions . Aliskiren-based therapy  produced sustained BP and PRA reductions over 26 weeks ; ramipril-based therapy lowered BP and increased PRA . PRA reductions persisted 4 weeks after stopping aliskiren , suggesting an inhibitory effect beyond the elimination half-life of the drug In this multicentre , prospect i ve , r and omized , open-label , blinded-endpoint ( PROBE ) study , the efficacy of 12 weeks ' treatment with once-daily telmisartan 40–80 mg and enalapril 10–20 mg was evaluated using ambulatory blood pressure monitoring ( ABPM ) in 522 patients with mild-to-moderate essential hypertension . Patients were titrated to the higher dose of study drug at week 6 if mean seated diastolic blood pressure ( DBP ) was ≥ 90 mmHg . The primary endpoint was the change from baseline in ambulatory DBP in the last 6 h of the 24-h dosing interval after 12 weeks ' treatment . Telmisartan and enalapril produced similar reductions from baseline in DBP and systolic blood pressure ( SBP ) over all ABPM periods evaluated ( last 6 h , 24-h , daytime and night-time ) . Telmisartan produced a significantly greater reduction in mean seated trough DBP , measured unblinded with an automated ABPM device in the clinic , amounting to a difference of −2.02 mmHg ( P < 0.01 ) . A significantly greater proportion of patients achieved a seated diastolic response  with telmisartan than enalapril ( 59 % versus 50 % ; P < 0.05 ) , also measured with the same ABPM device . Both treatments were well tolerated . Compared with telmisartan , enalapril was associated with a higher incidence of cough ( 8.9 % versus 0.8 % ) and hypotension ( 3.9 % versus 1.1 % ) . Therefore , telmisartan may provide better long-term compliance and , consequently , better blood pressure control than enalapril BACKGROUND Blood pressure ( BP ) has a circadian pattern with a morning surge that is associated with an increased risk of acute coronary and cerebrovascular events . In a prospect i ve , r and omized , open-label , blinded-endpoint , parallel-group , multicenter , forced-titration study of telmisartan and ramipril , the efficacy of both drugs on mean ambulatory diastolic BP ( DBP ) and systolic BP ( SBP ) during the last 6 h of a 24-h dosing interval was evaluated . METHODS After screening and a single-blind run-in phase , 812 adults with mild-to-moderate hypertension ( defined as a mean seated DBP > or = 95 mm Hg and < or = 109 mm Hg and a 24-h ABPM mean DBP 7 > or = 85 mm Hg ) were r and omized to the open-label , 14-week , forced-titration , active-treatment phase as follows : telmisartan 40 mg/80 mg/80 mg ( n = 405 ) or ramipril 2.5 mg/5 mg/10 mg ( n = 407 ) , once daily in the morning . The primary efficacy variable was change from baseline in the last 6-h mean DBP and SBP at 8 and 14 weeks as assessed by  ambulatory BP monitoring  ( ABPM ) . Secondary efficacy variables were changes from baseline in BP control during each of the 24-h periods and in-clinic trough cuff BP . RESULTS Telmisartan 80 mg was superior to ramipril 5 mg and 10 mg in change from baseline in the last 6-h ABPM mean DBP and SBP at both 8 and 14 weeks ( both P < .0001 ) , respectively . At 14 weeks , the adjusted mean change from baseline in DBP for telmisartan 80 mg was -8.8 mm Hg compared with that for ramipril 10 mg of -5.4 mm Hg ( P < .0001 ) . For SBP , the adjusted mean change from baseline for telmisartan 80 mg was -12.7 mm Hg compared with that for ramipril 10 mg of -7.9 mm Hg ( P < .0001 ) . At 14 weeks , telmisartan 80 mg also yielded superior reductions from baseline in trough cuff BP compared with ramipril 10 mg ( DBP : -11.0 mm Hg v -7.8 mm Hg , respectively ; SBP : -14.3 mm Hg v -9.1 mm Hg , respectively ; both P < .0001 ) . Measures of 24-h BP control favored telmisartan 80 mg versus ramipril 10 mg ( P < .0001 ) , as did other secondary ABPM endpoints during the daytime , night-time , and morning periods . Treatment-related adverse events were uncommon ; patients treated with ramipril had a higher incidence of cough than those treated with telmisartan ( 10.1 % v 1.5 % , respectively ) . CONCLUSIONS Telmisartan 80 mg was consistently more effective than ramipril 10 mg in reducing both DBP and SBP during the last 6 h of the dosing interval , a measure of the early morning period when patients are at greatest risk of life-threatening cardiovascular and cerebrovascular events . Telmisartan 80 mg was also more effective than ramipril 10 mg in reducing BP throughout the entire 24-h dosing interval . Both drugs were well tolerated Background : Attainment of blood pressure ( BP ) goals in patients with diabetes is critical both to reduce the risk of cardiovascular events and to delay the progression of renal disease . While therapeutic guidelines advise initial therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker , monotherapy with these agents may not be sufficient to attain target BP . Objective : The ADHT ( Amlodipine Diabetic Hypertension Efficacy Response Evaluation Trial ) evaluated the efficacy and safety of adding amlodipine to the treatment regimen of patients with hypertension and diabetes who were already receiving either quinapril or losartan as monotherapy . Methods : ADHT was a double-blind , double-dummy , 22-week trial conducted in the US , After a washout period of 7–13 days , patients ( aged 30–75 y ) with hypertension and diabetes were r and omized to receive quinapril 20 mg/day plus placebo or losartan 50 mg/day plus placebo for 4 weeks , titrated to 40 mg or 100 mg ( if required ) , respectively , for an additional 4 weeks to achieve their BP goals ( < 130/60 mm Hg ) , At week 8 , either amlodipine 5 mg/day or placebo was added for an additional 12 weeks , with titration to 10 mg at week 14 if the BP goal was not achieved . Results : Efficacy of add-on therapy was evaluated in 411 patients  ( amlodipine 211 , placebo 200 ) . BP goal was reached by 27.5 % of patients when amlodipine was added to quinapril or losartan monotherapy , compared with 12.5 
    Output:
    
RESULTS In spite of substantial new evidence , none of the conclusions from the 2007 review changed .
The level of evidence remains high for equivalence between ACE inhibitors and ARBs for blood pressure lowering and use as single antihypertensive agents , as well as for superiority of ARBs for short-term adverse events ( primarily cough ) .
However , the new evidence was insufficient on long-term cardiovascular outcomes , quality of life , progression of renal disease , medication adherence or persistence , rates of angioedema , and differences in key patient subgroups .
AND IMPLICATION S OF KEY FINDINGS Evidence does not support a meaningful difference between ACE inhibitors and ARBs for any outcome except medication side effects .