THE USE OF ARB'S AND ACE INHIBITOR
FOR THE TREATMENT OF HYPERTENSION
A.Q. Choudhury MS R.Ph.
Clinical Pharmacist, V.A. Hudson Valley Health Care System
SUMMARY
Angiotensin receptor blockers (ARB's) are widely used as an alternative to angiotension converting enzyme
(ACE) inhibitors for the treatment of hypertension because they lower the blood pressure without inducing
cough.
ARB's and ACE inhibitors have some differences in their pharmacological effects. ACE inhibitors suppress
angiotensin II production and therefore reduce activation of both of its receptors AT1 and AT2. ARB's interfere
with binding of Angiotensin II to AT1 receptors but have no effect on AT2 receptors, which activity may be bene-
ficial in hypertension but possibly not in the ischemic heart. ARB's also do not block breakdown of brady
kinine, which is thought to be responsible for the cough associated with ACE inhibitors.
It has been established that ARB's provide the same cardiac protection as ACE inhibitors but some available data
suggest that ARB's could increase the risk of myocardial infraction. Two control trials (LIFE and SCOPE) that
had patients with hypertension comparing losartan with atenolol and candeesartan with placebo initially fol-
lowed by antihypertensive treatment did not find any satisfactory significant difference in the incidence of
myocardial infraction. In another trial comparing losartan to the ACE inhibitor captopril in patients with heart
failure (ELITEII) or post-MI(OPTIMAAL)) , mortality lowered with captopril but the difference was not statisti-
cally significant. Post-MI patients with heart failure or left ventricular disfunction (VALIANT), valsartan was
not inferior to captopril in terms of mortality.
ANGIOTENSIN-RECEPTOR BLOCKERS (ARB'S)
GENERIC NAME DAILY DOSE TRADE NAME MANUFACTURER
a ieei
Candesart n c l x t l 8-32 mg Atacand AstraZeneca
Eprosartan 400-800 mg Teveten Biovail
Irbesartan 75-300 mg A vapro Bristol-Myers Squibb
Losartan 25-100 mg Cozaar Merck
Olmesartan 20-40 mg Benicar Sankyo
Telmisartan 40-80 mg i
Micard s Abbott
Valsartan 80-320 mg Diovan i
Novarts
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BANGLADESHI-AMERICAN PHARMACISTS’ ASSOCIATION
ADVERTISEMENT ARTICLES TOPICS AND PROFILES EDITORIAL MESSAGE PROGRAM CONTENTS COMMITTEE
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS
GENERIC NAME DAILY DOSE TRADE NAME MANUFACTURER
Benazepril 10-80 mg Lotensin i
Novarts
Captopril 12.5-450 mg Capoten Par
Enalapril 2.5-40 mg Vasotec Merck
Fosinopril 10-80 mg Monopril Bristol-Myers Squibb
iiorl
Lsnpi 5-80 mg rnvl
Piii Merck
eti
Zsrl AstraZeneca
Moexipril 7.5-30 mg Univasc Schwarz Pharm a
Perindopril 4-8 mg Aceon Solvay
Quinapril 5-80 mg pi
Accru r l fzr
Pie
Ramipril 2.5-20 mg Altace Monarch
Trandolapril 1-8 mg Mavik Abbott
CONCLUSION
It has not been established that ARB's provides the same cardiac benefits as ACE inhibitors. But recently pub-
lished editorials in the British Medical Journal suggested that ARB's may increase the risk of myocardial infrac-
tion.
1. S. Verma and M. Strauss. Angiotensin receptor blockers and myocardial infarction. BMJ 2004; 329: 1248
2. S. Julius et. al. Outcomes in hypertensive patients at high cardiovascular risk treated
3. MA Pfeffer et. al.Effects of candesartan on mortality and morbidity in patients with chronic heart failure
4. H Lithell et al. The study on cognition and prognosis in the elderly (SCOPE)
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JOURNAL 2005