27 Jul Hypertension: Fewer Side Effects with ARBs than ACE Inhibitors For New Patients

MedicalResearch.com Interview with:

Dr. Hripcsak

George Hripcsak, MD, MS.
Chair and Vivian Beaumont Allen Professor of Biomedical Informatics
Department of Biomedical Informatics,
Columbia University Irving Medical Center
New York, NY

MedicalResearch.com: What is the background for this study?

Response: ACE inhibitors and ARBs are anti-hypertension drugs that have related yet distinct mechanisms of action, and they are both recommended as first-line therapies for treating hypertension. There have been no large head-to-head comparisons of ACE inhibitors and ARBs, although there are several studies with limited size and often restricted (e.g., high-risk) populations. While there are some conflicting results in the literature, the current evidence seems to indicate that they are similar in effectiveness but that ACE inhibitors have more side effects (e.g., cough and angioedema).

MedicalResearch.com: What are the main findings?

Response: We confirmed that in our population of first-time anti-hypertension drug users, effectiveness was similar and that ACE inhibitors did indeed have more side effects. Cough and angioedema were clear. Pancreatitis and gastrointestinal bleed were also detected but did not pass the strict Bonferroni criteria, meaning that the differences for these latter two could still be due to chance.

MedicalResearch.com: What should readers take away from your report?

Response: Our report indicates that new hypertension patients should favor ARBs instead of ACE inhibitors. We did not study patients already taking anti-hypertensive medications, so our results do not directly pertain to patients switching drugs, and if patients are already tolerating their current anti-hypertensive medications well, our study does not point to changing.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should look at subgroups of patients who may see a difference in benefit between the two drug classes, and look at specific drugs within the classes.

Any disclosures? This study was funded in part by the National Institutes of Health and the National Science Foundation. Two authors are employees of Janssen Research and Development with interests in Johnson & Johnson, and the paper enumerates additional disclosures for the authors.

Citation:

Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study

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, George Hripcsak

Originally published26 Jul 2021https://doi.org/10.1161/HYPERTENSIONAHA.120.16667
Hypertension. ;0:HYPERTENSIONAHA.120.1666 

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Last Updated on July 27, 2021 by Marie Benz MD FAAD