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ACEIs for cardiovascular risk reduction--have we taken our eye off the ball?
Andrew Sindone1, Jonathan Erlich, Vlado Perkovic
1BMed(Hons), MD, FRACP, FCSANZ, is a cardiologist and Director, Heart Failure Unit and Department of Cardiac Rehabilitation, Concord Hospital, New South Wales.
Insights
Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are not interchangeable for managing hypertension. Clinical evidence suggests ACEIs may offer superior survival benefits for cardiovascular risk reduction.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension significantly increases cardiovascular (CV) event risk.
- Debate exists regarding the comparative efficacy of ACEIs and ARBs in reducing CV risk.
Purpose of the Study:
- To review evidence on ACEIs and ARBs for preventing CV events and mortality.
- To provide rationale for preferring ACEIs in specific patient groups for CV risk reduction.
Main Methods:
- Review of recent clinical trial evidence comparing ACEIs and ARBs.
- Analysis of factors influencing medication choice in hypertensive patients with CV risk factors.
Main Results:
- ACEIs and ARBs exhibit significant structural and functional differences, deeming them non-interchangeable.
- Clinical trials indicate potential advantages of ACEIs over ARBs, particularly concerning survival benefits.
- Increasing ARB prescriptions in Australia contrast with evidence suggesting ACEI superiority.
Conclusions:
- Treatment decisions for hypertension should prioritize absolute CV risk reduction over solely lowering blood pressure.
- The choice between ACEIs and ARBs should consider individual patient CV risk factors.
- ACEIs may be preferred for comprehensive CV risk reduction in certain hypertensive populations.
Background:
Hypertensive patients have an increased risk of cardiovascular (CV) events. There is debate whether angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) offer similar reductions in CV risk.
Objective:
This article discusses some of the recent evidence for the prevention of CV events and mortality with ACEIs and ARBs, and the rationale for using an ACEI as the preferred agent for comprehensive CV risk reduction in specific patient populations.
Discussion:
ACEIs and ARBs are structurally and functionally very different agents; they are not interchangeable. Prescriptions for ARBs are increasing in Australia. However, clinical trial evidence suggests possible advantages of ACEIs over ARBs, particularly in terms of survival benefit. Many patients with hypertension have other CV risk factors that may affect medication choice. The aim of treatment should not be just to lower blood pressure, but to reduce absolute CV risk.
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