Which medicine is best for you?

Tuesday, July 27, 2021 (HealthDay News)-Two long-used types Blood pressure medicine Larger “real-world” studies have shown that it is equally effective, but less popular ones have fewer side effects.

Both classes of drugs are recommended as “first-line” treatment High blood pressure: Angiotensin converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB).

Doctors prescribe them more often because ACE inhibitors have been around for a long time and are being studied more extensively.

But new discoveries suggest that ARB may be a better choice for people who are just starting to take medication, the researchers said.

“There was no difference in the effectiveness of the drug,” said principal investigator Dr. George Hripcsak. “If there are no side effects [with an ACE inhibitor], No need to switch. “

Looking at data from nearly 3 million patients, researchers found that ACE inhibitors and ARBs were equally effective in reducing risk. Heart disease When stroke..

What made them different was the side effects: ACE inhibitors were more likely to cause chronicity cough And angioedema — severe swelling of the face under the skin, often.

People taking ACE inhibitors have gastrointestinal (GI) bleeding or inflammation of pancreas.. But these differences may be due to chance, Hripcsak, a professor at Columbia University’s Bageros Medical College in New York City, warned.

In the future, doctors may want to prescribe ARB “priority” as the first treatment for hypertension, he said. This class of drugs includes losartan, balsartan, and candesartan.

But those who are already using ACE inhibitors and are doing well can stick to it. ACE inhibitors include lisinopril, captopril, and fosinopril.

This study was published online in the journal on July 26th. High blood pressure.

With a long list of hypertension drugs, the guidelines recommend both ACE inhibitors and ARBs as primary options. Both classes have proven effective in lowering blood pressure and reducing the risk of heart disease and stroke.

However, according to Hripcsak, few trials directly compare the two drug types to help doctors make prescribing decisions.

So his team turned to the actual data. They used several large databases in the United States, South Korea, and Europe, and used health records of about 3 million patients who newly launched ACE inhibitors or ARBs between 1996 and 2018. did.

The majority (about 2.3 million people) were prescribed ACE inhibitors as a single blood pressure drug. The rest (about 674,000) started at ARB.

Overall, the study found that there was no clear difference between the two groups in the average risk of suffering a heart attack, stroke, or heart failure.

However, studies show that patients with ACE inhibitors are three times more likely to develop angioedema and 32% more likely to develop a persistent cough.

The risk of gastrointestinal bleeding and pancreatitis was also slightly higher among users of ACE inhibitors. However, these numbers may be accidental discoveries because they could not withstand the statistical analysis performed by the researchers.

Dr. Willy Lawrence, a cardiologist at Center For Better Health in Benton Harbor, Michigan, said in his experience that gastrointestinal bleeding and pancreatitis are not drug issues.

“Patients should be aware that ACE inhibitors can cause coughing and angioedema. If you experience any of these symptoms, tell your doctor,” Lawrence said. rice field.

But like Hripcsak, he said patients doing well with ACE inhibitors have no reason to make changes.

For more information

American Heart Association Management of hypertension.

Source: George Hripcsak, MD, Professor and Chairman, Biomedical Informatics, Columbia University Vagelos College of Physicians and Surgeons, New York City. Dr. Willy Lawrence, MD, Head of the National Heart Association, Dallas National Hypertension Control Initiative Oversight Board, and Intervention Cardiologist, Better Health Center in Benton Harbor, Michigan. High blood pressure, July 26, 2021, online