Author + information
- Received November 9, 2017
- Revision received January 7, 2018
- Accepted January 18, 2018
- Published online March 26, 2018.
- Franz H. Messerli, MDa,b,∗ (, )
- Sripal Bangalore, MD, MHAc,
- Chirag Bavishi, MD, MPHd and
- Stefano F. Rimoldi, MDa
- aDepartment of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
- bDivision of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine, New York, New York
- cThe Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
- dDivision of Cardiology, Mount Sinai St. Luke’s & Mount Sinai West Hospitals, New York, New York
- ↵∗Address for correspondence:
Dr. Franz H. Messerli, Department of Cardiology, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland.
Most guidelines for the management of patients with cardiovascular disease recommend angiotensin-converting enzyme (ACE) inhibitors as first-choice therapy, whereas angiotensin receptor blockers (ARBs) are merely considered an alternative for ACE inhibitor–intolerant patients. The aim of this review was to compare outcomes and adverse events between ACE inhibitors and ARBs in patients. In patients with hypertension and hypertension with compelling indications, we found no difference in efficacy between ARBs and ACE inhibitors with regard to the surrogate endpoint of blood pressure and outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. However, ACE inhibitors remain associated with cough and a very low risk of angioedema and fatalities. Overall withdrawal rates because of adverse events are lower with ARBs than with ACE inhibitors. Given the equal outcome efficacy but fewer adverse events with ARBs, risk-to-benefit analysis in aggregate indicates that at present there is little, if any, reason to use ACE inhibitors for the treatment of hypertension or its compelling indications.
- adverse events
- angiotensin receptor blocker
- blood pressure
- chronic kidney disease
- coronary heart disease
- heart failure
- left ventricular hypertrophy
Dr. Messerli has served as a consultant or advisor for Daiichi-Sankyo, Pfizer, Abbott Vascular, Servier, Medtronic, WebMD, Menarini, Ipca, Hikma, American College of Cardiology, Relypsa, and Sandoz. Dr. Bangalore has received grants from Abbott Vascular and the National Heart, Lung, and Blood Institute; has been on the advisory boards of Abbott Vascular, Amgen, Menarini, Daiichi-Sankyo, Boehringer Ingelheim, Pfizer, The Medicines Company, and AstraZeneca; has been a consultant for Merck and Abbott Vascular; and has served as a consultant or advisor for Gilead. Dr. Rimoldi has had consultant or advisory relationships with Servier, Menarini, and Takeda; and has been on the speakers bureau for Menarini and Servier. Dr. Bavishi has reported that he has no relationships relevant to the contents of this paper to disclose.
Stanley Franklin, MD, served as Guest Editor for this paper.
- Received November 9, 2017.
- Revision received January 7, 2018.
- Accepted January 18, 2018.
- 2018 American College of Cardiology Foundation
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