ACE (angiotensin
Angiotensin
Angiotensin is a peptide hormone that causes vasoconstriction and a subsequent increase in blood pressure. It is part of the renin-angiotensin system, which is a major target for drugs that lower blood pressure. Angiotensin also stimulates the release of aldosterone, another hormone, fro…
Angiotensin II receptor antagonist
Angiotensin II receptor blockers, also known as angiotensin II receptor antagonists, AT₁ receptor antagonists or sartans, are a group of pharmaceuticals that modulate the renin–angiotensin system. Their main uses are in the treatment of hypertension, diabetic nephropa…
Blood pressure
Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels. When used without further specification, "blood pressure" usually refers to the arterial pressure in the systemic circulation. It is usually measured at a person's upper arm.
Are ACE inhibitors better than ARBs for first-line hypertension?
ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs) are equally guideline-recommended first-line treatments for hypertension, yet few head-to-head studies exist. We compared the real-world effectiveness and safety of ACE inhibitors versus ARBs in the first-line treatment of hypertension.
Are ACE inhibitors safe and effective for HTN?
Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study. Hypertension 2021;Jul 26: [Epub ahead of print]. As first-line management of HTN, ACE inhibitors and ARBs have similar cardiovascular outcomes.
How effective are ARBs for preventing hypertension complications?
Although there’s some conflicting data, most previous studies have found that ARBs have similar effectiveness as ACE inhibitors for preventing hypertension complications, with better tolerability. Cough and angioedema —swelling in the deep layers of the skin and other tissues—are among the ACE inhibitors’ well-known adverse effects.
What do we know about angiotensin receptor blockers (ARBs)?
The appearance of angiotensin receptor blockers (ARBs) amongst the therapeutic options in the treatment of cardiovascular diseases (CVDs) was a new milestone in the history of hypertension treatment.
Why are ACE inhibitors used before ARBs?
“ACE inhibitors cause your body to make less angiotensin II while ARBs block the effects of angiotensin II, both of which work to reduce blood pressure,” wrote Chen, who was a postdoctoral fellow at Columbia University during the study and is now an assistant professor in translational data science and informatics at ...
Are ARBs first line treatment for hypertension?
Currently, ACE inhibitors and ARBs are both recommended as first-line therapies for the treatment of hypertension according to US and European guidelines.
Why would you switch from ACE to ARB?
Both ACE inhibitor and ARB have shown comparable long-term benefit in prevention of adverse cardiovascular events which makes the switch justifiable, moreover with reduction of cough which can be misinterpreted as one of COVID-19 signs.
When do you use ACE vs ARB?
ARBs are as effective as ACE inhibitors and have a better tolerability profile. ACE inhibitors cause more angioedema in African Americans and more cough in Chinese Americans than in the rest of the population. ACE inhibitors and most ARBs (except for losartan) increase the risk of gout.
Why is ACE first line for hypertension?
Introduction. ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs) effectively lower blood pressure (BP) through inhibition of the renin-angiotensin system and are equally recommended as first-line medications in the treatment of hypertension.
What is the first line treatment for hypertension?
There are three main classes of medication that are usually in the first line of treatment for hypertension: 1. Calcium Channel Blockers (CCB) 2. Angiotensin Converting Enzyme inhibitors (ACE inhibitors or ACE-I) and Angiotensin Receptor Blockers (ARBs) 3. Diuretics.
Why should you not combine an ACEI and ARB?
Avoid prescribing an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin receptor blocker (ARB) for patients at high risk of vascular events or renal dysfunction. The combination does not reduce poor outcomes, and leads to more adverse drug-related events than an ACE inhibitor or ARB alone.
What happens if you take an ACE and ARB together?
Combining angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduces admissions for heart failure in patients with congestive heart failure (CHF), but with an increased rate of adverse effects and no reduction in mortality or overall hospitalization rates (SOR: A, meta-analysis of ...
What is the major difference between ARBs and ACE inhibitors?
ARBs inhibit the binding of angiotensin II (A-II) to A-II type 1 (AT1) receptors in a competitive manner, while ACE inhibitors reduce RAAS activity by inhibiting the conversion of A-I into A-II [5].
Is ACE or ARB better for hypertension?
Researchers found that while ACE inhibitors and ARBs are similarly beneficial, the latter carry a lower risk of side effects.
Why are ACE inhibitors used for hypertension?
ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder.
What is the risk of stage 2 hypertension?
For those with stage 2 hypertension or with preexisting cardiovascular disease, diabetes mellitus, chronic kidney disease, or a 10-year risk of cardiovascular disease of 10% or higher , both lifestyle change and medication are recommended.
Can blood pressure medications reduce blood pressure?
A: Multiple clinical trials have shown that blood pressure can be effectively reduced by medications and that doing so results in a reduced incidence of target-organ events. The initial agent can be selected from one of four drug classes: angiotensin-converting–enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), calcium-channel blockers, and thiazide-type diuretics; each class has been shown to reduce cardiovascular events. The patient’s lifestyle, coexisting conditions, and clinical characteristics should be considered in selecting an agent. For example, patients with a high salt intake (e.g., eating primarily processed foods) may have a greater blood-pressure reduction with diuretic therapy, whereas those restricting salt intake may have a greater response to blockade of the renin–angiotensin system.
Study Questions
How do angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) compare in efficacy and safety when initiated as first-line treatment for hypertension (HTN)?
Methods
Using 5 US administrative claims databases and 3 US electronic health databases of more than 2.3 million patients initiating antihypertensive agents, researchers compared clinical endpoints, safety, and adverse effects between ACE inhibitors and ARBs using propensity score models.
Results
When outcomes were compared with ARB use, ACE inhibitor use was associated with similar risk of acute myocardial infarction, heart failure, hemorrhagic or ischemic stroke, or a quadruple composite with sudden cardiac death.
Conclusions
In the largest head-to-head propensity-matched observational network study comparison between ACE inhibitors and ARBs for first-line HTN treatment, there were no differences in cardiovascular outcomes including acute myocardial infarction, heart failure, stroke, or composite cardiovascular events.
Perspective
This study evaluated real-world outcome of patients with newly treated HTN initiating treatment with either an ACE inhibitor or ARB. The authors suggest the study supports starting ARBs over ACE inhibitors.
What is the HTN stage?
The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of HTN stages is: Normal blood pressure (BP): systolic BP is less than 120, and diastolic BP is less than 80. Elevated BP: systolic BP 120 to 130 ...
What is the target BP for kidney disease?
In patients with chronic kidney disease, the target BP is 130/80. For patients with type 2 diabetes mellitus (T2DM), it is recommended to start on antihypertensive medications if BP is more than 130/80 with a goal of BP lower than 130/80.
How do beta blockers work?
Beta-blockers work by inhibiting the catecholamines from binding to the Beta 1,2, and 3 receptors. Beta-1 receptors are found primarily in the heart muscle, beta-2 receptors are located in the bronchial and peripheral vascular smooth muscles, and beta-3 receptors appear in adipose tissue of the heart.
Does hydrochlorothiazide lower blood pressure?
Switching to chlorthalidone from hydrochlorothiazide decreases systolic blood pressure by 7 to 8 mm Hg.
Is chlorthalidone better than hydrochlorothiazide?
They are better at decreasing the risk of cardiovascular disease comparing to hydrochlorothiazide. [4][5] Chlorthalidone is the drug of choice to start as monotherapy for hypertension. Studies show it to be the best diuretic to control blood pressure and to prevent mortality and morbidity.
Is spironolactone a good antihypertensive?
Spironolactone is superior to doxazosin and bisoprolol in lowering blood pressure when added to first-line antihypertensive agents in treating resistant hypertension. [28] Hydralazine can be added for the treatment of resistant hypertension, either alone or in combination with nitrates, in case of heart failure.
Is a beta blocker a diuretic?
The beta-blocker and diuretic combination is associated with a higher incidence of diabetes. Clinicians should use combinations containing beta-blockers when beta-blockers are indicated in patients with heart failure, tachycardia, or post-MI patients.
Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study
Department of Biomedical Informatics, Columbia University Irving Medical Center, New York (R.C., P.B.R., G.H.).
Novelty and Significance
This large-scale propensity-matched network study represents the largest head-to-head comparison of ACE (angiotensin-converting enzyme) inhibitors with angiotensin receptor blockers (ARBs) for the first-line treatment of hypertension
