ARBs are preferable to ACEIs when initiating blood pressure-lowering therapy because of their superior safety, say researchers who led the largest comparative study to date.

Although both agents are considered first line, ACEIs are associated with a higher rate of adverse events, such as angioedema and pancreatitis, US researchers say.

The team stresses, however, that data show the drugs are equally effective in preventing major cardiovascular events.

The biomedical informatics experts at Columbia University in New York analysed data from eight international databases on about three million adults initiating renin-angiotensin-aldosterone system (RAAS) blockade monotherapy from 1996 to 2018.