Common Medications Provide Equal Blood Pressure Control

November 2017

Pharmaceutical News

Country of origin: USA

Two common classes of blood pressure medications - angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) - are equally effective at controlling high blood pressure, according to a report released by the Agency for Healthcare Research and Quality (AHRQ), part of the US Department of Health and Human Services (HHS).

The report, which analysed published results from 61 studies, also found that ACEIs are slightly more likely than ARBs to cause a harmless but persistent dry cough.

Authors of the report also said that more research is needed to learn how ACEIs and ARBs may differ when it comes to longer term benefits and harms. In particular, more information is needed about how the medications may differ in decreasing the risks of heart attack, stroke, or death.

?An enormous number of Americans have high blood pressure, and we need to provide them with the best information possible about their medications? potential benefits and harms,? said AHRQ Director Carolyn M. Clancy, M.D. ?This report summarises the current scientific evidence on these medications and helps set the agenda for needed research.?

The study compared both the benefits and harms of ACEIs and ARBs. Both classes of drugs control blood pressure effectively by targeting a key hormone that helps regulate blood pressure. The study did not include other blood pressure treatments such as diuretics or beta blockers.

The ACEIs included in the AHRQ analysis were benazepril (sold as Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik). The ARBs included were candesartan cilexetil (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan medoxomil (Benicar), telmisartan (Micardis), and valsartan (Diovan).

Among the report?s conclusions:

? ACEIs and ARBs are equally effective at controlling blood pressure. This conclusion is based on studies that included 16,597 patients who were followed for periods from 12 weeks to 5 years.
? In studies of patients in everyday clinical settings, a dry cough was reported by about 1.7 percent of patients who took ACEIs and about 0.6 percent who took ARBs. Patients who took ACEIs in clinical trials were slightly more likely than patients who took ARBs to withdraw from the studies.
? It is unknown whether ACEIs and ARBs differ when it comes to long-term benefits and risks. Among available studies, there are not enough cases of death or stroke to make conclusions. More research is needed.
? There are no consistently apparent differences between ACEIs and ARBs when it comes to impacting blood fats known as lipids, managing or slowing the progression of diabetes, controlling renal disease, or impacting heart function.
? More research is needed to compare the drugs? benefits and harms for hypertension patients who have additional health problems, such as diabetes, congestive heart failure, chronic kidney disease, and dyslipidemia. Future studies should include more patients who are older and from ethnic and racial minorities.

A summary of the report, 'Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension', is available online.

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