This study "confirms that ARBs appear to have fewer side effects than ACE inhibitors, and no unexpected ARB side effects were detected," Dr. George Hripcsak, chair of biomedical informatics at Columbia University Vagelos College of Physicians and Surgeons and senior author of the paper, told Reuters Health by email.
ACE inhibitors are "much more" commonly prescribed, likely because they are more familiar (to clinicians) and because there was previously a large difference in cost," Dr. Hripcsak noted. But this analysis suggests clinicians should "favor ARBs instead of ACE inhibitors in new hypertension patients," he said.
Using claims and electronic health data from the United States, Germany and South Korea, the researchers compared the real-world safety and effectiveness of ACE inhibitors and ARBs in the first-line single-agent treatment of hypertension in adults with no history of heart disease or stroke.
They identified about 2.3 million patients initiating monotherapy with an ACE inhibitor and about 674,000) initiating an ARB.
They saw no statistically significant differences between the two drug classes in the primary outcomes of acute myocardial infarction, heart failure, stroke or composite cardiovascular events, according to the Hypertension journal report.
"We did not detect a difference in effectiveness. Therefore this study largely confirms what was already suspected and may help doctors to feel more comfortable to start new hypertension patients on ARBs instead of ACE inhibitors," Dr. Hripcsak told Reuters Health.
And ARBs may be easier to take. Across secondary and safety outcomes, patients taking an ARB had significantly lower risk of angioedema, cough, pancreatitis and gastrointestinal bleeding.
The study has several limitations, including the wide variation in the length of time patients were included in the different databases. Also, most patients taking an ACE inhibitor (80%) were on lisinopril. The most commonly used ARB (45%) was losartan. Therefore, the results may not be fully generalizable to other drugs in each class.
Dr. Hripcsak said it's important to note that the study did not include patients already taking antihypertensive medications, "so our results do not directly pertain to patients switching drugs, and if patients are already tolerating their current antihypertensive medications well, our study does not point to changing."
The study was supported by the National Library of Medicine and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; the National Science Foundation; and the Ministries of Health & Welfare and of Trade, Industry & Energy of the Republic of Korea. A complete list of author disclosures is available with the original article.
SOURCE: https://bit.ly/3iOvBDe Hypertension, online July 26, 2021.
By Megan Brooks
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