Comparison of Blood Pressure Meds Points to Similar Benefit, but Different Adverse Effects


The American Heart Association recently released new findings on 2 classes of blood pressure medications.

The American Heart Association (AHA) journal Hypertension published an analysis that looked at approximately 3 million patients taking a single high blood pressure medication for the first time. The analysis showed that 2 types of blood pressure-lowering medications—angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—demonstrated similar benefits, but different adverse effects (AEs).

Patients in the beginning stages of treatment for high blood pressure can benefit from taking either ACE inhibitors or ARBs.

ACE inhibitors lower blood pressure in the body by blocking an enzyme early in the system so that less angiotensin is produced. Angiotensin is a chemical that narrows blood vessels, and the lowering of angiotensin production allows the blood vessels to remain wider and more relaxed. In comparison, ARBs diminish the blood vessels from constricting by blocking receptors in the blood vessels that angiotensin would attach to. These medicine classes affect the renin-angiotensin-aldosterone hormone system to regulate blood pressure.

The study report looked at the health records of patients on first-time blood pressure medication treatment from 1996 through 2018. A total of 51 possible AEs and safety concerns were examined.

According to the analysis, ARBs were identified as equal to ACE inhibitors in treating hypertension and preventing heart attack, stroke, and heart failure. Patients who took ARBs had better outcomes and were less likely to develop tissue swelling, cough, pancreas inflammation, and bleeding in the digestive tract. Further, ARBs may be less likely to cause AEs, according to the data.

Patients prescribed ACE inhibitors demonstrated 3 times more prevalence in developing fluid accumulation and swelling in the deep skin and membranes. Additionally, these patients were 32% more likely to acquire a cough, and 32% more likely to develop bleeding in the gastrointestinal tract.

The occurrence of heart-related events and stroke were also compared by researchers. No significant differences in the occurrence of heart attack, stroke, hospitalization for heart failure, or any cardiac event were identified.

Currently, ACE inhibitors are prescribed more commonly than ARBs for first-time blood pressure control medicine; however, the analysis points to starting hypertension treatment with ARBs over ACE inhibitors, according to the study authors.

The authors noted that the results from this analysis may not be generalizable to individuals with hypertension who have been prescribed multiple or combination treatments or who switch from 1 type of medication to another. In addition to encouraging patients to live a healthy lifestyle and taking blood pressure medication as prescribed, the AHA recommends regular self-blood pressure evaluation with a validated device and working with a health care professional to work towards reducing blood pressure.1


Two types of blood pressure meds prevent heart events equally, but side effects differ. News release. American Heart Association;July 26, 2021. Accessed July 27, 2021.

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