ARBs appear to have fewer side effects, same effectiveness compared to ACE inhibitors
Researchers used large international databases to compare outcomes among patients who initiated hypertension therapy with angiotensin-converting enzyme (ACE) inhibitors versus angiotensin receptor blockers (ARBs) and concluded that ARBs should be preferred.
Patients who were put on an angiotensin receptor blocker (ARB) for hypertension had similar rates of cardiovascular events and lower rates of angioedema, cough, pancreatitis, and gastrointestinal bleeding than those who started an angiotensin-converting enzyme (ACE) inhibitor, a recent study found.
The retrospective study compared the drug classes among new-user cohorts of all patients with hypertension initiating monotherapy with an ACE inhibitor or ARB between 1996 and 2018 across eight databases from the U.S., Germany, and South Korea. The primary outcomes were acute myocardial infarction, heart failure, stroke, and composite cardiovascular events, and there were 51 secondary and safety outcomes, including angioedema, cough, syncope, and electrolyte abnormalities. The results were published by Hypertension on July 26.
The study included 2,297,881 patients initiating treatment with ACE inhibitors and 673,938 patients starting ARBs. There were no statistically significant differences in the primary outcomes of acute myocardial infarction (hazard ratio [HR], 1.11 for ACE vs. ARB; 95% CI, 0.95 to 1.32), heart failure (HR, 1.03; 95% CI, 0.87 to 1.24), stroke (HR, 1.07; 95% CI, 0.91 to 1.27), or composite cardiovascular events (HR, 1.06; 95% CI, 0.90 to 1.25). Patients on ACE inhibitors had significantly higher risk of angioedema (HR, 3.53; 95% CI, 2.99 to 4.16), cough (HR, 1.32; 95% CI, 1.23 to 1.42), pancreatitis (HR, 1.32; 95% CI, 1.09 to 1.60), and gastrointestinal bleeding (HR, 1.18; 95% CI, 1.11 to 1.25).
The results are largely concordant with previous research on the effectiveness and safety of these drug classes, the study authors said. “This study represents the largest head-to-head comparison of ACE inhibitors with ARBs and supports the preferential prescribing of ARBs over ACE inhibitors,” they wrote. The study authors noted that current guidelines recommend the drug classes equally but that “These results lend further support to recent calls for the differentiation and elevation of ARBs as first-line therapy over ACE inhibitors in the treatment of hypertension.”