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Effectiveness Similar for First-Line ACE Inhibitors, ARBs in HTN

Risks for angioedema, cough, pancreatitis, and GI bleeding significantly lower with ARBs for first-line HTN treatment

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MONDAY, July 26, 2021 (HealthDay News) -- For patients with hypertension initiating treatment, effectiveness is comparable for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), but ARBs have a better safety profile, according to a study published online July 26 in Hypertension.

RuiJun Chen, M.D., from the Columbia University Irving Medical Center in New York City, and colleagues compared the real-world effectiveness and safety of ACE inhibitors versus ARBs in first-line treatment of hypertension. All patients with hypertension initiating monotherapy with an ACE inhibitor or ARB between 1996 and 2018 from eight databases across the United States, Germany, and South Korea were included.

The researchers identified 2,297,881 patients initiating treatment with ACE inhibitors and 673,938 initiating treatment with ARBs. The primary outcomes of acute myocardial infarction, heart failure, stroke, or composite cardiovascular events did not differ significantly between the groups. Of 51 secondary and safety outcomes examined, significantly lower risks for angioedema, cough, pancreatitis, and gastrointestinal bleeding were seen for patients on ARBs.

"Despite being equally guideline-recommended first-line therapies for hypertension, these results support preferentially starting ARBs rather than ACE inhibitors when initiating treatment for hypertension for physicians and patients considering renin-angiotensin system inhibition," the authors write.

Several authors disclosed financial ties to the biopharmaceutical, technology, legal, health, insurance, and other industries.

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