People who are just beginning treatment for high blood pressure can benefit equally from two different classes of medicine - angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) - yet ARBs may be less likely to cause medication side effects, according to an analysis of real-world data published today in Hypertension, an American Heart Association journal.
While the class of blood pressure-lowering medicines called angiotensin-converting enzyme (ACE) inhibitors may be prescribed more commonly, angiotensin receptor blockers (ARBs) work just as well and may cause fewer side effects. Currently, ACE inhibitors are prescribed more commonly than ARBs as a first-time blood pressure control medicine.
Both types of medicines work on the renin-angiotensin-aldosterone system, a group of related hormones that act together to regulate blood pressure. ACE inhibitors lower blood pressure by blocking an enzyme early in the system so that less angiotensin, a chemical that narrows blood vessels, is produced, and blood vessels can remain wider and more relaxed. ARBs block receptors in the blood vessels that angiotensin attaches to, diminishing its vessel-constricting effect.
The AHA/ACC 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults says the primary medications for treating high blood pressure are thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers as they have been shown to reduce cardiovascular events. Physical activity and other lifestyle changes are recommended for managing all levels of high blood pressure, even if medication is required.
However, they found significant differences in the occurrence of four medication side effects. Compared with those taking ARBs, people taking ACE inhibitors were:
- 3.3 times more likely to develop fluid accumulation and swelling of the deeper layers of the skin and mucous membranes (angioedema);
- 32% more likely to develop a cough (which may be dry, persistent, and bothersome);
- 32% more likely to develop sudden inflammation of the pancreas (pancreatitis); and
- 18% more likely to develop bleeding in the gastrointestinal tract;
"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," said George Hripcsak, M.D., senior author of the study and professor 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," said 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."
