Angiotensin receptor blockers may be preferable to ACE inhibitors due to safety profile
Angiotensin receptor blockers don’t significantly differ compared with ACE inhibitors as first-line treatment for patients with hypertension, but do present with a better safety profile, researchers reported.
“In professional guidelines, several classes of medications are equally recommended as first-line therapies,” RuiJun Chen, MD, MA, postdoctoral research scientist in the department of biomedical informatics at Columbia University Irving Medical Center and assistant professor in the department of translational data science and informatics at Geisinger, Danville, Pennsylvania, said in a press release. “With so many medicines to choose from, we felt we could help provide some clarity and guidance to patients and health care professionals.”
The retrospective, new-user comparative multinational cohort study published in Hypertension included 2,297,881 patients with hypertension who initiated ACE inhibitor monotherapy and 673,938 who initiated angiotensin receptor blockers between 1996 and 2018. Researchers obtained the data from eight databases from the U.S., Germany and South Korea.
The primary outcomes were acute MI, HF, stroke and composite CV events.
There was no statistically significant difference between those taking ACE inhibitor and angiotensin receptor blockers in acute MI (HR = 1.11; 95% CI, 0.95-1.32), HF (HR = 1.03; 95% CI, 0.87-1.24), stroke (HR = 1.07; 95% CI, 0.91-1.27) or composite CV events (HR = 1.06; 95% CI, 0.9-1.25).
However, compared with those taking angiotensin receptor blockers, those taking ACE inhibitors demonstrated significantly increased risks for acute pancreatitis (HR = 1.32; 95% CI, 1.04-1.7; P = .02), angioedema (HR = 3.31; 95% CI, 2.55-4.51; P < .01), cough (HR = 1.32; 95% CI, 1.11-1.59; P < .01), gastrointestinal bleeding (HR = 1.18; 95% CI, 1.01-1.41; P = .04) and abnormal weight loss (HR = 1.18; 95% CI, 1.01-1.41; P = .04), as well as decreased risk for abnormal weight gain (HR = 0.84; 95% CI, 0.74-0.98; P = .04).
According to the researchers, these findings support starting angiotensin receptor blockers instead of ACE inhibitors if the intent is to treat hypertension through renin-angiotensin system inhibitors.
The results are not necessarily applicable to patients already taking ACE inhibitors or patients taking more than one medication, Chen said in the release.
“While current U.S. and European guidelines consider ACE inhibitors and angiotensin receptor blockers to be equally recommended first-line therapies and other international guidelines group ACE inhibitors and angiotensin receptor blockers together as a single treatment category, these results lend further support to recent calls for the differentiation and elevation of angiotensin receptor blockers as first-line therapy over ACE inhibitors in the treatment of hypertension,” the researchers wrote.
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