Patients taking angiotensin receptor blockers (ARBs) for the treatment of high blood pressure experienced fewer side effects than those taking angiotensin-converting enzyme (ACE) inhibitors, according to a new study published in Hypertension.
The study’s authors analyzed the efficacy and safety data from 2,297,881 patients who were prescribed ACE inhibitors compared with 673,938 who were given ARBs in the first-line treatment of hypertension.
Of the patients who received ACE inhibitors, 80% were prescribed lisinopril, followed by ramipril and enalapril, while 45% of the ARB cohort were administered losartan, then valsartan and olmesartan.
After examining the risk of 55 potential outcomes—4 primary and 51 secondary—there were no statistically significant differences reported in the primary outcomes of MI, heart failure, stroke or composite cardiovascular events.
However, a considerably lower risk of angioedema, cough, pancreatitis, and GI bleeding was seen in patients on ARBs.
“In professional guidelines, several classes of medications are equally recommended as first-line therapies," lead author RuiJun Chen, MD, MA, assistant professor in translational data science and informatics at Geisinger Medical Center in Danville, Pennsylvania, said in a preprepared statement. "With so many medicines to choose from, we felt we could help provide some clarity and guidance to patients and health care professionals."
In contrast with patients taking ARBs, those who were prescribed ACE inhibitors were:
- 3.3 times more likely to develop fluid accumulation and swelling of the deeper layers of the skin and mucous membranes (angioedema)
- 32% more likely to develop a cough (which may be dry, persistent, and bothersome)
- 32% more likely to develop sudden inflammation of the pancreas (pancreatitis)
- 18% more likely to develop bleeding in the gastrointestinal tract
“We did not detect a difference in how the two types of medicine reduced the complications of hypertension, but we did see a difference in side effects,” added senior author George Hripcsak, MD, professor and chair of biomedical informatics at Columbia University Vagelos College of Physicians and Surgeons. “If a patient is starting hypertension therapy for the first time, our results point to starting with the ARB over the ACE inhibitor.”
Read the full study here.