Angiotensin Receptor Blockers Equally Effective as ACE Inhibitors For Treating Hypertension, May Result in Fewer Adverse Events


Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are equally effective in the treatment of hypertension, but ARBs may be less likely to result in adverse events (AEs), according to a study published in Hypertension. ACE inhibitors are currently prescribed more commonly than ARBs as a first-time blood pressure control medicine despite this difference in AEs, the study authors noted.

“In professional guidelines, several classes of medications are equally recommended as first-line therapies. With so many medicines to choose from, we felt we could help provide some clarity and guidance to patients and health care professionals,” said RuiJun Chen, MD, MA, assistant professor in translational data science and informatics at Geisinger Medical Center, in a press release.

The study authors reviewed the health records of patients who began first-time blood pressure-lowering treatment using a single medicine between 1996 and 2018. The investigators compared the occurrence of heart-related events and stroke between patients receiving ACE inhibitors and those receiving ARBs.

Heart-related events were defined as heart attack, heart failure, stroke, or any combination of of these events, as well as sudden cardiac death. They also compared the rates of occurrence for 51 different AEs between the 2 groups. The study included 2,297,881 patients treated with ACE inhibitors and 673,938 patients treated with ARBs.

Although there was no significant difference found in the rates of occurrence for heart attack, stroke, hospitalization for heart failure, or any other cardiac event, the investigators found a considerable difference in the rates of 4 AEs. Those taking ACE inhibitors were 3.3 times more likely to develop angioedema—fluid accumulation and swelling of the deeper layers of the skin and mucous membranes—32% more likely to develop a cough, 32% more likely to develop sudden inflammation of the pancreas (pancreatitis), and 18% more likely to develop bleeding in the gastrointestinal tract.

“ARBs do not differ in effectiveness and may have fewer side effects than ACE inhibitors among those just beginning treatment,” Chen said in the release. “We unfortunately cannot extend these conclusions to people who are already taking ACE inhibitors or those who are taking multiple medications. We would reiterate that if you experience any side effects from your medicine, you should discuss with your doctor whether your antihypertensive regimen may need to be adjusted.”


Two types of blood pressure meds prevent heart events equally, but side effects differ [news release]. EurekAlert; July 26, 2021. Accessed July 26, 2021.

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