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Why are ACE inhibitors more commonly used than Angiotensin Receptor Antagonists?

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  • Why are ACE inhibitors more commonly used than Angiotensin Receptor Antagonists?

    I have been doing some research for my cardiovascular essay recently.
    And despite the mechanism of action of ACE inhibitors and ARBs being similar, and ACEi causing the cough and angiodema, why are ACEi more commonly used than ARBs as first line treatment of cardiovascular disease, and why are ARBs suggested as alternatives instead of being the first line use of treament.

    I just wanted to know if theres an advantage of ACE inhibitors that I am missing. Thank you


  • #2
    The history of Ace inhibitors is interesting. Squib sent an expedition into the jungle to look for possible new meds.
    While there they were told of snakes (Enalaprids I believe) who captured their prey by making them faint. The venom was found to drop the blood pressure. So, Squib launched the first of these meds as Capoten. MSD soon followed with Enalapril and many others have followed. I use to take Candesartan, but it was stopped by my Dr as a possible toxin for the kidney. I well remember the days when there was virtually no treatment for blood pressure except salt restriction.
    My best friend's mother collapsed and died from a massive stroke and I have a history of strokes in my family.
    Now you have the ABCD of meds: Ace Inhibitors, Beta Blockers, Calcium antagonists, and Diuretics.
    johnep

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    • ato_cr
      ato_cr commented
      Editing a comment
      Thank you for the response.
      So the reason for their preference as first line over ARBs is due to the fact they have been around longer right? And it's not much to do with how effective they are?

  • #3
    Probably. took a long time for Digitalis and then Digoxin use to decline.
    johnep

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    • #4
      ACE inhibitors came first which is always an advantage in gaining market share.
      They come in a range of strengths which makes titration easier.
      Serious side effects are only seen in a minority of patients.
      Main reason why they are first choice is probably down to cost.

      Comment


      • ato_cr
        ato_cr commented
        Editing a comment
        thanks i appreciate it

    • #5
      Errrrrr has no one considered EVIDENCE!?

      In a very basic nutshell the evidence in hypertension is they are similar.

      In heart failure the evidence is that ACEis are significantly superior. But there are different types just as there is a myriad of cardiovascular disease issues. Many other issues such as ethnicity may need to be considered. There isn’t a one size fits all answer for all CV issues.

      Suggest you look at NICE clinical guidance for these two conditions and avoid anecdotal bumf such as cost first to market, what happened to me etc. If you’ve included that in your essay I wouldn’t anticipate too high marks.

      Good luck

      Comment


      • ato_cr
        ato_cr commented
        Editing a comment
        I appreciate it thank you
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