oa SA Pharmaceutical Journal - ACE inhibitors and ARBs : cost-effectiveness and safety : review



Medicines that affect the renin-angiotensin-aldosterone system are effective in several diseases. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II, while angiotensin-receptor blockers (ARBs) selectively inhibit angiotensin II from activating the angiotensin-specific receptor (AT). Studies found that the two drug classes are equally safe and effective at managing hypertension, and have similar effects on other risk factors and clinical outcomes in patients with essential hypertension. It has also been confirmed that ARBs are less likely to cause coughing, but it has been suggested that this side-effect might be less common with ACE inhibitors than randomised trials indicate. Therefore, two important questions arise: which drug class is more effective, and what would the effect be if the two classes were used together? A recent study reported that restricting the prescribing of ARBs, so that they are given only to patients who are intolerant to ACE inhibitors, could save millions of dollars in health care costs, without any adverse effects on cardiovascular health. Despite the fact that both ACE inhibitors and ARBs are important in the treatment of essential hypertension, there is a lack of comparative evidence of the long-term benefits and harms of these two classes of agents. Only a few studies have compared ACE inhibitors and ARBs for periods longer than one year, and there is a lack of research on the pharmacoeconomic aspects of these two drug classes. More studies are needed.


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