ACEI vs ARB

[Pharmacie]

What is the diffrence between ACEI and ARB.Actually,I know only one important use of ARB that is it's used if the patient has ACEI-induced cogh.Both classes are effective in reducing blood pressure.There is one disadvantage regarding ARB that is the price , ARB are more expensive.

Thanks

[Nik]

A good pharmacology textbook such as Rang and Dale will explain the different mechanisms of action. MMDT is also useful:

Introduction: Arterial Hypertension: Merck Manual Professional

[bolam]

Ace inhibitors block the angiotensin converting enzyme so prevent the formation of angiotensin 2 , whereas ARB block the receptors onto which this acts. A cough is not seen with ARB as it doesnt increase bradykinin levels like ace inhibitors do.( I would still look in Rang and Dale for a more concise explanation)

[Pharmacie]

Hello
I don' mean the pharmacological diffrence between the two calsses.What I mean is,the therapeutic difference.Under which circumstances the use of ARB is better or prefered?
Even in the case of compelling indications such as Diabetes , CKD , prior stroke , acute CAD or chronic CAD ACEI is used ( ARB is an alternative if the patient can't tolerate ACEI )
The side effects of the two classes almost the same ( not used in pregnancy , increase serum creatinine , hyperkalemia ).There is just one difffrence that is cough

[Shaeeb]

There's no big difference - cost is the main issue. Although I have read that ARBs have better outcomes in the tx of HF of the LSVD type. Otherwise ACE-1 suffices as long as no ADR esp. cough or contraindications.

[crit care]

isn't one of the A2 antagonists coming off patent..want to say losartan.....?? i'm sure i've seen page spreads in the PJ about it

[Shaeeb]

Yes, losartan has been off patent for quite some time now. So the PCT's recommend this as a first line choice of ARB where an ACE-1 is contraindicated.