Two Types of Blood Pressure Medicine Prevent Heart Events Equally, however Side Effects Differ

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  • In an analysis of practically 3 million clients taking a single hypertension medication for the very first time, angiotensin receptor blockers (ARBs) were as excellent as angiotensin-converting enzyme (ACE) inhibitors at avoiding cardiovascular occasions connected to high blood pressure, consisting of cardiac arrest, stroke, and cardiac arrest.
  • 51 possible negative effects and security issues were taken a look at: The clients taking ARBs were discovered to be substantially less most likely to establish tissue swelling, cough, pancreas swelling, and bleeding in the gastrointestinal system.
  • This info might help clinicians in choosing which kind of blood pressure-lowering medication to recommend for clients identified with high blood pressure for the very first time.

People who are simply starting treatment for hypertension can benefit similarly from 2 various classes of medication – angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) – yet ARBs might be less most likely to trigger medication negative effects, according to an analysis of real-world information released on July 26, 2021, in Hypertension, an American Heart Association journal.

While the class of blood pressure-lowering medications called angiotensin-converting enzyme (ACE) inhibitors might be recommended more frequently, angiotensin receptor blockers (ARBs) work simply as well and might trigger less negative effects. Currently, ACE inhibitors are recommended more frequently than ARBs as a newbie high blood pressure control medication.

The findings are based upon an analysis of 8 electronic health record and insurance coverage claim databases in the United States, Germany, and South Korea that consist of practically 3 million clients taking a hypertension medication for the very first time without any history of heart problem or stroke.

Both kinds of medications deal with the renin-angiotensin-aldosterone system, a group of associated hormonal agents that act together to control high blood pressure. ACE inhibitors lower high blood pressure by obstructing an enzyme early in the system so that less angiotensin, a chemical that narrows capillary, is produced, and capillary can stay larger and more unwinded. ARBs obstruct receptors in the capillary that angiotensin connects to, lessening its vessel-constricting result.

“In professional guidelines, several classes of medications are equally recommended as first-line therapies. With so many medicines to choose from, we felt we could help provide some clarity and guidance to patients and health care professionals,” stated RuiJun Chen, M.D., M.A., lead author of the research study, assistant teacher in translational information science and informatics at Geisinger Medical Center in Danville, Pennsylvania, and NLM postdoctoral fellow at Columbia University at the time of the research study.

The AHA/ACC 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults states the main medications for dealing with hypertension are thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers as they have actually been revealed to decrease cardiovascular occasions. Physical activity and other way of life modifications are advised for handling all levels of hypertension, even if medication is needed.

Health records for clients who started newbie blood pressure-lowering treatment with a single medication in between 1996-2018 were examined for this research study. Researchers compared the incident of heart-related occasions and stroke amongst 2,297,881 clients treated with ACE inhibitors to those of 673,938 clients treated with ARBs. Heart-associated occasions consist of cardiac arrest, cardiac arrest or stroke, or a mix of any of these occasions or abrupt heart death tape-recorded in the database. The scientists likewise compared the incident of 51 various negative effects in between the 2 groups. Follow-up times differed in the database records, however they varied from about 4 months to more than 18 months.

They discovered no substantial distinctions in the incident of cardiac arrest, stroke, hospitalization for cardiac arrest, or any heart occasion. However, they discovered substantial distinctions in the incident of 4 medication negative effects. Compared with those taking ARBs, individuals taking ACE inhibitors were:

  • 3.3 times most likely to establish fluid build-up and swelling of the much deeper layers of the skin and mucous membranes (angioedema);
  • 32% most likely to establish a cough (which might be dry, relentless, and irritating);
  • 32% most likely to establish abrupt swelling of the pancreas (pancreatitis); and
  • 18% most likely to establish bleeding in the intestinal system;

“We did not detect a difference in how the two types of medicine reduced the complications of hypertension, but we did see a difference in side effects,” stated George Hripcsak, M.D., senior author of the research study and teacher and chair of biomedical informatics at Columbia University Vagelos College of Physicians and Surgeons and medical informatics services director at New York-Presbyterian/Columbia University Irving Medical Center. “If a patient is starting hypertension therapy for the first time, our results point to starting with the ARB over the ACE inhibitor.”

“ARBs do not differ in effectiveness and may have fewer side effects than ACE inhibitors among those just beginning treatment,” stated Chen. “We, unfortunately, cannot extend these conclusions to people who are already taking ACE inhibitors or those who are taking multiple medications. We would reiterate that if you experience any side effects from your medicine, you should discuss with your doctor whether your antihypertensive regimen may need to be adjusted.”

The research study is restricted by broad variation in the length of time clients were consisted of in the various databases. Although lots of people were followed for an extended period of time, those who had much shorter follow-up durations might not have actually taken the medications enough time to experience their complete advantages in avoiding heart disease occasions. Most of the individuals taking ACE inhibitors (80%) were taking lisinopril, and the most secondhand ARB (45% of those taking this class of medication) was losartan, so the outcomes might not be totally generalizable to other medications in these classes. It is likewise crucial to keep in mind that arises from this analysis of first-line treatment might not be generalizable to individuals with high blood pressure who have actually been recommended mix treatment or who change from one kind of medication to another.

“In addition to encouraging patients to live a healthy lifestyle and taking medication as prescribed to control blood pressure, the American Heart Association recommends regular self-blood pressure monitoring with a validated device and working with a health care professional on a plan to reduce blood pressure,” stated Willie Lawrence, M.D., interventional cardiologist and medical director for Health Equity, Spectrum Health, Benton Harbor, Michigan and head of the American Heart Association’s National Hypertension Control Initiative Oversight Committee.

For more on this research study, read Less Popular Blood Pressure Medication Is the (Slightly) Safer Choice.

Reference: “Comparative first-line effectiveness and safety of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: a multinational cohort study” by
RuiJun Chen, Marc A. Suchard, Harlan M. Krumholz, Martijn J. Schuemie, Steven Shea, Jon Duke, Nicole Pratt, Christian G. Reich, David Madigan, Seng Chan You, Patrick B. Ryan and George Hripcsak, 26 July 2021, Hypertension.
DOI: 10.1161/HYPERTENSIONAHA.120.16667

Co-authors are Marc A. Suchard, M.D., Ph.D.; Harlan M. Krumholz, M.D., S.M.; Martijn J. Schuemie, Ph.D.; Steven Shea, M.D.; Jon Duke, M.D.; Nicole Pratt, Ph.D.; Christian G. Reich, M.D., Ph.D.; David Madigan, Ph.D.; Seng Chan You, M.D.; and Patrick B. Ryan, Ph.D. Disclosures remain in the manuscript.

The research study was supported by the National Library of Medicine and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; the National Science Foundation; and the Ministries of Health & Welfare and of Trade, Industry & Energy of the Republic of Korea.