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

Abstract

Most guidelines for the management of patients with cardiovascular disease recommend angiotensin-converting enzyme (ACE) inhibitors as first-choice therapy, whereas angiotensin receptor blockers (ARBs) are merely considered an alternative for ACE inhibitor-intolerant patients. The aim of this review was to compare outcomes and adverse events between ACE inhibitors and ARBs in patients. In patients with hypertension and hypertension with compelling indications, we found no difference in efficacy between ARBs and ACE inhibitors with regard to the surrogate endpoint of blood pressure and outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. However, ACE inhibitors remain associated with cough and a very low risk of angioedema and fatalities. Overall withdrawal rates because of adverse events are lower with ARBs than with ACE inhibitors. Given the equal outcome efficacy but fewer adverse events with ARBs, risk-to-benefit analysis in aggregate indicates that at present there is little, if any, reason to use ACE inhibitors for the treatment of hypertension or its compelling indications.

• Authors: Franz H Messerli, Sripal Bangalore, Chirag Bavishi, Stefano F Rimoldi
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 71 Issue 13 Pg. 1474-1482 (04 03 2018) ISSN: 1558-3597 [Electronic] United States
• PMID: 29598869 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Antihypertensive Agents

Topics

• Angioedema (chemically induced, epidemiology)
• Angiotensin II Type 1 Receptor Blockers (adverse effects, therapeutic use)
• Angiotensin Receptor Antagonists (adverse effects, therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (adverse effects, therapeutic use)
• Animals
• Antihypertensive Agents (adverse effects, therapeutic use)
• Blood Pressure (drug effects, physiology)
• Cardiovascular Diseases (chemically induced, epidemiology)
• Clinical Trials as Topic (methods)
• Drug Therapy, Combination
• Humans
• Hypertension (drug therapy, epidemiology, physiopathology)
• Renin-Angiotensin System (drug effects, physiology)