Two kinds of drugs that are advised as a very first treatment for clients with hypertension were discovered similarly efficient in enhancing cardiovascular results, however the more popular type triggers a little more adverse effects, discovers an international observational research study led by scientists at Columbia University Vagelos College of Physicians and Surgeons.
The research study, which examined claims and electronic health information from countless clients worldwide, is the biggest to compare the security and effectiveness of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), 2 frequently recommended antihypertensive drugs.
“Physicians in the United States and Europe overwhelmingly prescribe ACE inhibitors, simply because the drugs have been around longer and tend to be less expensive than ARBs,” states George Hripcsak, MD, the Vivian Beaumont Allen Professor and chair of biomedical informatics at Columbia University Vagelos College of Physicians and Surgeons and senior author of the research study.
“But our study shows that ARBs are associated with fewer side effects than ACE inhibitors. The study focused on first-time users of these drugs. If you’re just starting drug therapy for hypertension, you might consider trying an ARB first. If you’re already taking an ACE inhibitor and you’re not having any side effects, there is nothing that we found that would indicate a need for a change.”
The research study was released online in Hypertension.
Narrowing Down Choices
Once a doctor chooses to recommend medication to manage a client’s hypertension, the next choice — which one to pick — is made complex.
“U.S. and European hypertension guidelines list 30 medications from five different drug classes as possible choices, yet there are very few head-to-head studies to help physicians determine which ones are better,” Hripcsak states. “In our research, we are trying to fill in this information gap with real-world observational data.”
ACE inhibitors and ARBs are amongst the options, and they have a comparable system of action. Both decrease the danger of stroke and cardiac arrest, though it’s understood that ACE inhibitors are related to increased danger of cough and angioedema (extreme swelling in the face and respiratory tracts).
“We wanted to see if there were any surprises — were both drug classes equally effective, and were ARBs producing any unexpected side effects when used in the real world?” Hripcsak states. “We’re unlikely to see head-to-head clinical trials comparing the two since we are reasonably sure that both are effective.”
Electronic Health Records Provide Answer
The scientists rather relied on big databases to address their concerns. They examined insurance coverage claims and electronic health records from around 3 million clients in Europe, Korea, and the United States who were beginning antihypertensive treatment with either an ACE inhibitor or an ARB.
Data from electronic health records and insurance coverage claims are challenging to utilize in research study. They can be unreliable, insufficient, and consist of details that predispositions the outcomes. So the scientists utilized a range of advanced mathematical methods established by the Observational Health Data Science and Informatics (OHDSI) collective network to considerably decrease predisposition and balance the 2 treatment groups as if they had actually been registered in a potential research study.
Using this method, the scientists tracked 4 cardiovascular results — cardiac arrest, cardiac arrest, stroke, and abrupt heart death — and 51 negative occasions in clients after they began antihypertensive treatment.
The scientists discovered that the huge bulk of clients — 2.3 million — were recommended an ACE inhibitor. There were no substantial distinctions in between the 2 drug classes in decreasing the danger of significant cardiovascular issues in individuals with high blood pressure. Patients taking ACE inhibitors had a greater danger of cough and angioedema, however the research study likewise discovered they had a somewhat greater danger of pancreatitis and intestinal bleeding.
“Our study largely confirmed that both antihypertensive drug classes are similarly effective, though ARBs may be a little safer than ACE inhibitors,” Hripcsak states. “This provides that extra bit of evidence that may make physicians feel more comfortable about prescribing ARBs versus ACE inhibitors when initiating monotherapy for patients with hypertension. And it shows that large-scale observational studies such as this can offer important insight in choosing among different treatment options in the absence of large randomized clinical trials.”
Reference: “Comparative first-line effectiveness and safety of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: a multinational cohort study” 26 July 2021, Hypertension.
DOI: 10.1161/HYPERTENSIONAHA.120.16667
Additional authors are RuiJun Chen (Geisinger Health), Marc Suchard (University of California Los Angeles), Harlan Krumholz (Yale University), Martijn Schuemie (Janssen Research and Development), Steven Shea (Columbia), Jon Duke (Georgia Tech College of Computing), Nicole Pratt (University of South Australia), Christian Reich (OHDSI), David Madigan (Northeastern University), Seng Chan You (Ajou University School of Medicine), and Patrick Ryan (Janssen).
The research study was moneyed by the National Institutes of Health, National Science Foundation, and the Ministries of Health & Welfare and of Trade, Industry & Energy, Republic of Korea.
