OBJECTIVE:Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are widely used for the treatment of hypertension. However, data on their comparative efficacy is incomplete. The present systematic review and network meta-analysis investigated the comparative efficacy of these two drug categories in blood pressure reduction, mortality and morbidity of adults with essential hypertension. DESIGN AND METHOD:Bibliographic search was performed in Medline (PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL) for placebo- and active-controlled, double-blind randomized trials, which had studied for blood pressure reduction, mortality and/or morbidity. RESULTS:Thirty studies with 7370 participants were included for the blood pressure reduction analysis and eight studies with 25158 participants were included for the mortality/morbidity analysis. The two pharmacological categories did not differ in lowering systolic (WMD0.59, 95%CI−0.21 to 1.38) and diastolic blood pressure (WMD0.62, 95%CI−0,06 to 1.30), all-cause mortality (RR0.96, 95%CI 0.80 to 1.14), cardiovascular mortality (RR0.87, 95%CI 0.67 to 1.14), fatal and non-fatal myocardial infarction (RR1.02, 95%CI 0.75 to 1.37) and stroke (RR1.13, 95%CI 0.87 to 1.46). ACEIs found to be superior in the development and/or hospitalization for heart failure (RR0.71, 95%CI 0.54 to 0.93). CONCLUSIONS:ACEIs and ARBs do not differ in blood pressure reduction, mortality and morbidity in patients with essential hypertension. ACEIs were superior in the development and/or hospitalization for heart failure.