Newer, More Tolerable Blood Pressure Drugs as Effective as Older Ones

Newer blood pressure drugs are as safe and effective as older medications, new research suggests. Scientists at the NYU Langone Medical Center (New York, NY) said their findings settle a longstanding debate about which of the two types of blood-pressure lowering medications is better.

An analysis of 106 randomized trials involving more than 250,000 patients was done to compare newer angiotensin receptor blockers (ARBs)with older angiotensin-converting enzyme (ACE) inhibitors. Although ACE inhibitors were developed 10 years earlier, both types of drugs showed similar effects in the analysis, challenging previous findings that suggest ACE inhibitors have greater benefits.

According to the new analysis, published online January 4 in Mayo Clinic Proceedings, the only difference between the medications is that ARBs are more easily tolerated than ACE inhibitors. “There has been debate for many years over the safety and efficacy of ACE inhibitors compared to ARBs, with many of them using an ‘ACE inhibitor-first’ approach, with ARBs regarded as less effective,” explained study author Sripal Bangalore, MD, in a news release. “We believe that our study ends the debate and gives physicians the option to prescribe either drug for their patients.”

Both ARBs and ACE inhibitors interfere with the function of a hormone called angiotensin II, which regulates blood pressure by restricting blood flow through vessels, but they each do this in different ways. ACE inhibitors prevent the body from making angiotensin II, while ARBs prevent the hormone from doing its job by taking its place on the surface of blood vessel cells, the researchers explained.

Previous studies had suggested that older ACE inhibitors are more effective than ARBs, but this latest analysis attributed those findings to changes in the standard of care over the decade between most trials of each of the two types of drugs, as well as a greater emphasis on quitting smoking and the wider use of cholesterol-lowering drugs called statins. Findings from trials conducted at similar times indicate that one drug was not more effective than the other.

“This is the first time that we have a clear and consistent message from the three buckets of trials of ACE inhibitors and ARBs, all of which show that there is no outcome difference between the two agents, except for better tolerability of ARBs,” Dr Bangalore said. “The results of our analysis are especially important for patients, given that many ARBs are now also generic, which reduces their costs.” —Amanda Del Signore