“But our study shows that ARBs are associated with fewer side effects than ACE inhibitors. The study focused on first-time users of these drugs. If you’re just starting drug therapy for hypertension, you might consider trying an ARB first. If you’re already taking an ACE inhibitor and you’re not having any side effects, there is nothing that we found that would indicate a need for a change.”
The research was revealed on-line in Hypertension.
Narrowing Down Choices
Once a doctor decides to prescribe remedy to regulate a affected person’s hypertension, the subsequent decision–which one to choose–is difficult.
“U.S. and European hypertension guidelines list 30 medications from five different drug classes as possible choices, yet there are very few head-to-head studies to help physicians determine which ones are better,” Hripcsak says. “In our research, we are trying to fill in this information gap with real-world observational data.”
ACE inhibitors and ARBs are among the many decisions, they usually have the same mechanism of motion. Both cut back the chance of stroke and coronary heart assaults, although it is recognized that ACE inhibitors are related to elevated threat of cough and angioedema (extreme swelling within the face and airways).
“We wanted to see if there were any surprises–were both drug classes equally effective, and were ARBs producing any unexpected side effects when used in the real world?” Hripcsak says. “We’re unlikely to see head-to-head clinical trials comparing the two since we are reasonably sure that both are effective.”
Electronic Health Records Provide Answer
The researchers as a substitute turned to massive databases to reply their questions. They analyzed insurance coverage claims and digital well being information from roughly 3 million sufferers in Europe, Korea, and the United States who had been beginning antihypertensive therapy with both an ACE inhibitor or an ARB.
Data from digital well being information and insurance coverage claims are difficult to make use of in analysis. They might be inaccurate, incomplete, and comprise info that biases the outcomes. So the researchers employed quite a lot of cutting-edge mathematical strategies developed by the Observational Health Data Science and Informatics (OHDSI) collaborative community to dramatically cut back bias and steadiness the 2 therapy teams as if they’d been enrolled in a potential research.
Using this strategy, the researchers tracked 4 cardiovascular outcomes–heart assault, coronary heart failure, stroke, and sudden cardiac death–and 51 antagonistic occasions in sufferers after they began antihypertensive therapy.
The researchers discovered that the overwhelming majority of patients–2.3 million–were prescribed an ACE inhibitor. There had been no important variations between the 2 drug lessons in lowering the chance of main cardiovascular issues in folks with hypertension. Patients taking ACE inhibitors had the next threat of cough and angioedema, however the research additionally discovered they’d a barely increased threat of pancreatitis and gastrointestinal bleeding.
“Our study largely confirmed that both antihypertensive drug classes are similarly effective, though ARBs may be a little safer than ACE inhibitors,” Hripcsak says.
“This provides that extra bit of evidence that may make physicians feel more comfortable about prescribing ARBs versus ACE inhibitors when initiating monotherapy for patients with hypertension. And it shows that large-scale observational studies such as this can offer important insight in choosing among different treatment options in the absence of large randomized clinical trials.”
Source: Eurekalert
