Ace versus arb
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Summary
10 papers analyzed
These studies suggest that ACE inhibitors and ARBs are similarly effective in lowering blood pressure and preventing cardiovascular events, with ARBs having a better safety profile and fewer side effects like coughing.
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Comparative Effectiveness of ACE Inhibitors vs. ARBs
Introduction to ACE Inhibitors and ARBs
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are widely used medications for managing cardiovascular conditions, particularly hypertension. Both drug classes target the renin-angiotensin system but through different mechanisms. ACE inhibitors block the conversion of angiotensin I to angiotensin II, while ARBs block the receptors for angiotensin II. This article synthesizes recent research comparing the effectiveness and safety of ACE inhibitors and ARBs.
Cardiovascular Outcomes in High-Risk Patients
Composite Cardiovascular Events
Several studies have evaluated the impact of ACE inhibitors and ARBs on cardiovascular outcomes in high-risk patients without heart failure. A network meta-analysis involving 27 randomized controlled trials (RCTs) with 125,330 patients found no significant differences between ACE inhibitors and ARBs in preventing cardiovascular death, myocardial infarction (MI), and stroke. Similarly, another large-scale observational study with over 2.9 million patients found no significant differences in the primary outcomes of acute MI, heart failure, stroke, or composite cardiovascular events between the two drug classes.
Mortality and Major Cardiovascular Events
In patients with diabetes, ACE inhibitors have been shown to reduce all-cause mortality, cardiovascular mortality, and major cardiovascular events compared to placebo or other treatments, whereas ARBs did not show significant differences for these outcomes except for heart failure. Another meta-analysis confirmed that ACE inhibitors significantly reduced the risk of cardiovascular death, MI, stroke, all-cause death, new-onset heart failure, and new-onset diabetes mellitus, while ARBs were effective in reducing stroke and new-onset diabetes mellitus.
Safety Profile and Side Effects
Adverse Events
The safety profiles of ACE inhibitors and ARBs differ notably. ACE inhibitors are associated with a higher incidence of cough and angioedema compared to ARBs . A comprehensive study across multiple databases found that patients on ARBs had a significantly lower risk of angioedema, cough, pancreatitis, and gastrointestinal bleeding compared to those on ACE inhibitors.
Renal Outcomes
Chronic Kidney Disease (CKD)
In patients with chronic kidney disease (CKD), both ACE inhibitors and ARBs have been shown to reduce the risk of kidney failure and major cardiovascular events. However, ACE inhibitors were found to be superior in reducing all-cause mortality compared to ARBs. This suggests that ACE inhibitors might be the preferred choice for patients with CKD.
Diabetes Prevention
New-Onset Diabetes
Both ACE inhibitors and ARBs have been associated with a reduction in the incidence of new-onset type 2 diabetes. A meta-analysis of 12 RCTs found that ACE inhibitors and ARBs reduced the incidence of newly diagnosed diabetes by 27% and 23%, respectively. This indicates that both drug classes can be beneficial in preventing diabetes in high-risk individuals.
Conclusion
In summary, ACE inhibitors and ARBs are both effective in managing hypertension and reducing cardiovascular events in high-risk patients. While ACE inhibitors may offer additional benefits in reducing all-cause mortality and preventing new-onset diabetes, ARBs have a better safety profile with fewer adverse effects such as cough and angioedema. The choice between ACE inhibitors and ARBs should be individualized based on patient-specific factors, including comorbid conditions and tolerance to side effects.
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