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Blood pressure drugs with bonus benefits

Both ACE inhibitors and ARBs also help stave off complications from heart failure and kidney disease.

When doctors prescribe drugs to treat high blood pressure, they often turn to two classes of medications: ACE inhibitors and angiotensin-receptor blockers (ARBs). These drugs are the first-line choice for people who also have diabetes—a common condition that often goes hand in hand with elevated blood pressure. Not only do these medications help prevent heart attacks in people with diabetes, they’re also useful for people with weakened hearts and ailing kidneys.

“These two classes of drugs have a ‘halo effect,’ because they also help lower the risk of heart failure and slow the progression of kidney disease,” says Dr. Marc Pfeffer, professor of medicine at Harvard Medical School. The two classes of drugs work in similar ways and have comparable benefits and side effects—with one exception that’s an issue for some people. Here’s an overview of these two medication mainstays for people with cardiovascular disease.

Side effects

Like all blood pressure–lowering drugs, ACE inhibitors and ARBs sometimes make people feel lightheaded or dizzy. Both can also cause a dry cough that can range from a mild nuisance to being so aggravating that people stop taking the drug. This side effect is more common with ACE inhibitors, occurring in about nine in 100 people versus just two in 100 people taking ARBs. If you develop a cough while taking an ACE inhibitor, ask your physician about trying an ARB instead.

About one in 100 people taking ACE inhibitors develops angioedema, which causes the lips, tongue, and throat to swell. Although this side effect is not common, it can trigger serious breathing problems, so tell your doctor if you notice it. This uncommon reaction is also possible with ARBs, but like the cough, it seems to be even less common than with ACE inhibitors.

In 2010, a controversial study suggested a link between ARBs and cancer, especially lung cancer. But an FDA analysis that looked at data from 31 separate studies of ARBs found no evidence to support that assertion. The cancer rate among people taking placebos was 1.84 per 100 per year, compared with 1.82 per 100 people taking an ARB.

ACE inhibitors vs. ARBs

ACE inhibitors vs. ARBs

ARB

Full name

angiotensin-converting
enzyme inhibitor

angiotensin II–receptor
blocker

How it works

reduces angiotensin II, an enzyme that causes blood pressure to rise

blocks the entry of
angiotensin II into cells

Drug names end in

-pril

“-sartan”

First approved

1981

1995

Examples

benazepril (Lotensin), enalapril (Vasotec), lisinopril (Zestril, Prinivil)

candesartan (Atacand), olmesartan (Benicar), valsartan (Diovan)

Number available

10

8

Available as generic

all 10

all except azilsartan (Edarbi)

Is one type better?

Numerous studies on both of these classes of drugs suggest that they’re very similar with regard to their long-term benefits for the heart and kidneys. “After nearly 20 years of research on these agents, I don’t think anyone can say one class is better than the other in terms of outcomes,” says Dr. Pfeffer. And there’s no evidence that taking both types of drugs together offers any advantage. In fact, doing so can increase your risk of side effects, says Dr. Pfeffer. If your doctor prescribes one of these classes of drugs, the choice will likely depend on which one your insurance plan covers. To save money, make sure you get a generic version, and talk to your doctor if you develop worrisome side effects. 

Posted by: Dr.Health

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