Review: No reason to use ACE inhibitors for hypertension
Messerli F, et al. J Am Coll Cardiol. 2018;doi:10.1016/j.jacc.2018.01.058.
March 26, 2018
Franz H. Messerli
In a review published in the Journal of the American College of Cardiology, four experts stated there is no reason to use ACE inhibitors to treat hypertension when angiotensin receptor blockers can be used instead.
“Because efficacy is similar but adverse events are fewer with [angiotensin receptor blockers], risk-to-benefit analysis in aggregate indicates that at present there is little, if any, clinical reason to use ACE inhibitors for the treatment of hypertension and so-called compelling indications,” Cardiology Today Editorial Board Member Franz H. Messerli, MD, from the department of cardiology and clinical research, University Hospital, Bern, Switzerland, and the division of cardiology, Mount Sinai Medical Center, Icahn School of Medicine, and colleagues wrote.
The researchers reviewed the literature to compare the safety and efficacy of ACE inhibitors and angiotensin receptor blockers for the treatment of hypertension and hypertension associated with compelling indications, including CAD, HF, chronic kidney disease (CKD), diabetes and cerebrovascular disease.
For BP reduction, “no clinically meaningful difference in antihypertensive efficacy” has been demonstrated between the two drug classes, and “meta-analyses of clinical trials suggest numerically greater reductions in office systolic and diastolic BP with [angiotensin receptor blockers] when compared with ACE inhibitors,” Messerli and colleagues wrote.
Clinical trials have not demonstrated any difference in efficacy between the two drug classes for reducing CV outcomes in patients with hypertension or at high risk for CV events, according to the authors.
Among patients with CAD, angiotensin receptor blockers “reduce CV events, including the risk of MI, as effectively but more safely than ACE inhibitors,” Messerli and colleagues wrote.
Among patients with HF, both drug classes have been shown to be more effective than placebo, and a significant all-cause mortality benefit has been seen with ACE inhibitors but not angiotensin receptor blockers, but the sample size for angiotensin receptor blockers is much smaller, the authors wrote.
Most studies of the drugs in patients with CKD have shown no difference in benefit, but one study of more than 14,000 patients with CKD found that mortality rates were higher in those using ACE inhibitors than in those using angiotensin receptor blockers, according to the researchers.
Most studies of the drugs in patients with diabetes have shown no difference in benefit, but one found angiotensin receptor blockers were better at reducing events than ACE inhibitors regardless of diabetes history, Messerli and colleagues wrote.
The drugs have shown no difference in stroke rates in patients with cerebrovascular disease, according to the researchers.