Angiotensin-Converting Enzyme Inhibitors in Hypertension: To Use or Not to Use?

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Clinical Trials

Background:

• Current cardiovascular disease guidelines often prioritize angiotensin-converting enzyme (ACE) inhibitors.
• Angiotensin receptor blockers (ARBs) are typically reserved as alternatives for patients intolerant to ACE inhibitors.

Purpose of the Study:

• To conduct a comparative review of outcomes and adverse events between ACE inhibitors and ARBs.
• To evaluate the risk-benefit profile of ARBs versus ACE inhibitors in managing hypertension and related conditions.

Main Methods:

• Systematic review and meta-analysis of clinical studies comparing ACE inhibitors and ARBs.
• Analysis focused on surrogate endpoints like blood pressure and hard clinical outcomes including mortality and major cardiovascular events.
• Adverse event profiles, including cough and angioedema, and drug withdrawal rates were assessed.

Main Results:

• No significant differences in efficacy were observed between ARBs and ACE inhibitors for blood pressure control and major cardiovascular outcomes.
• ACE inhibitors were associated with a higher incidence of cough and a low risk of angioedema and fatalities.
• Overall withdrawal rates due to adverse events were lower for ARBs compared to ACE inhibitors.

Conclusions:

• ARBs demonstrate comparable efficacy to ACE inhibitors in treating hypertension and its compelling indications.
• ARBs present a more favorable safety profile, characterized by fewer adverse events and lower withdrawal rates.
• The risk-benefit analysis suggests ARBs may be a preferred therapeutic option over ACE inhibitors for hypertension management.