ACE Inhibitors vs ARBs for Hypertension
SOURCE: Kaplan NM. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for hypertension: Are they equivalent? J Am Soc Hypertens 2015;9:582-583.
Recommendations from the panel assigned to develop Eighth Joint National Committee hypertension guidelines indicate that angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) (as well as thiazide-type diuretics and calcium channel blockers) are all appropriate initial therapies for hypertension in the general non-black population. For persons with chronic kidney disease and hypertension, this same document suggests ACE inhibitors or ARBs, without distinction. But should we consider ACE inhibitors and ARBs essentially interchangeable? An editorial review of this issue in the Journal of the American Society of Hypertension suggests otherwise, preferring ACE inhibitors over ARBs both in the general population and persons with diabetes.
The endorsement for ACE inhibitors over ARBs by this editorialist does not stem from a large randomized trial comparing the two. Rather, meta-analyses of a large number of hypertension trials has shown that whereas ACE inhibitors consistently reduced cardiovascular mortality, including myocardial infarction, ARBs do not demonstrate the same convincing risk reduction, especially for myocardial infarction. Since a large randomized trial comparing ACE inhibitors to ARBs is highly unlikely in the near future, if at all, this data review would support using ACE inhibitors preferentially over ARBs in most patients with hypertension.
This data review would support using angiotensin-converting-enzyme inhibitors preferentially over angiotensin II receptor blockers in most patients with hypertension.
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