Ace or arb
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
ACE Inhibitors vs. ARBs: A Comparative Analysis
Introduction to ACE Inhibitors and ARBs
Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) are widely used medications for managing hypertension, heart failure, and chronic kidney disease. Both drug classes work by interfering with the renin-angiotensin-aldosterone system (RAAS), but they do so through different mechanisms. This article synthesizes recent research to compare the effectiveness, safety, and specific applications of ACE inhibitors and ARBs.
ACE Inhibitors and ARBs in COVID-19
Impact on ACE2 Expression
Concerns have been raised about the safety of ACE inhibitors and ARBs during the COVID-19 pandemic due to their potential impact on ACE2 expression, the receptor for SARS-CoV-2. However, a comprehensive review of studies in both animals and humans indicates that these medications do not significantly increase ACE2 expression, particularly in human subjects. Therefore, the use of ACE inhibitors and ARBs does not appear to elevate the risk of COVID-19 complications.
COVID-19 Outcomes in African American Populations
A study focusing on the African American population found that in-hospital use of ARBs was associated with a significant reduction in in-hospital mortality among COVID-19 patients. This effect was not observed with ACE inhibitors, suggesting a potential advantage of ARBs in this specific context.
Prevention of Type 2 Diabetes
A meta-analysis of randomized clinical trials has shown that both ACE inhibitors and ARBs are effective in reducing the incidence of new-onset type 2 diabetes. The pooled analysis indicated a 25% reduction in the incidence of diabetes, making these medications a viable option for patients with pre-diabetic conditions.
Cardiovascular Outcomes
Comparative Effectiveness in Cardiovascular Patients
A network meta-analysis comparing ACE inhibitors and ARBs in high cardiovascular risk patients without heart failure found no significant differences between the two drug classes in preventing cardiovascular death, myocardial infarction, or stroke. Both drug classes were similarly effective in reducing the risk of new-onset heart failure and diabetes.
First-Line Treatment for Hypertension
A large-scale observational study comparing the real-world effectiveness and safety of ACE inhibitors and ARBs as first-line treatments for hypertension found no significant differences in primary cardiovascular outcomes. However, ARBs were associated with a better safety profile, including lower risks of angioedema, cough, and gastrointestinal bleeding.
Perioperative Management
A meta-analysis examining the perioperative use of ACE inhibitors and ARBs in noncardiac surgery found that withholding these medications did not affect mortality or major cardiac events but was associated with a reduced incidence of intraoperative hypotension. This suggests that withholding ACE inhibitors or ARBs may be beneficial in managing intraoperative blood pressure without increasing the risk of adverse outcomes.
Renal Outcomes
Renoprotection in Diabetic and Non-Diabetic Patients
The renoprotective effects of ACE inhibitors and ARBs have been well-documented, particularly in patients with chronic kidney disease. However, a systematic review and meta-analysis indicated that the benefits observed in placebo-controlled trials might be primarily due to blood pressure reduction rather than specific renoprotective actions. In diabetic nephropathy, the additional renoprotective benefits of these medications remain unproven.
Conclusion
Both ACE inhibitors and ARBs are effective and safe options for managing hypertension, preventing cardiovascular events, and reducing the incidence of type 2 diabetes. While ARBs may offer a better safety profile and specific advantages in certain populations, such as African Americans with COVID-19, the choice between these two drug classes should be individualized based on patient-specific factors and clinical context. Further research is needed to clarify their comparative benefits in various clinical scenarios.
Sources and full results
Most relevant research papers on this topic