High Blood Pressure Medications: ACE Inhibitors vs. ARBs

What is hypertension?

Hypertension (aka. high blood pressure) is when the pressure in your blood vessels is too high. According to current standards set by the American Heart Association (AHA), normal blood pressure is less than 120/80 mmHg, and Stage 2 hypertension is a blood pressure measurement of 140/90 mmHg or higher. You can find more information from the AHA on blood pressure here.

You don’t feel high blood pressure like you feel a headache. High blood pressure often has no signs or symptoms, so many people don’t know whether their blood pressure is high until they’ve had it checked.

Yes, blood pressure may rise temporarily in certain stressful situations, but we’re talking about when it stays elevated for a long time. Chronic high blood pressure can be a big problem as it increases the risk for kidney disease, heart disease, heart attacks, strokes and even death.

How do ACE inhibitors and ARBs compare?

ACE inhibitors, or angiotensin-converting enzyme inhibitors, include lisinopril (Zestril), benazepril (Lotensin) and enalapril (Vasotec). ARBs, or angiotensin-receptor blockers, include losartan (Cozaar), valsartan (Diovan) and irbesartan (Avapro).

How they work

ACE inhibitors and ARBs work on the same biochemical pathway in the body to stop high blood pressure, but at different spots.

ACE inhibitors block a natural substance in the body called angiotensin I from being converted to angiotensin II. Angiotensin II constricts the blood vessels, causing blood pressure to increase. Stopping the conversion of angiotensin I to angiotensin II results in blood vessel relaxation and a decrease in blood pressure.

ARBs also target the angiotensin pathway, but they work by blocking angiotensin II from binding to receptors on the blood vessels that affect blood vessel constriction. In the end, this also results in blood vessel relaxation and a decrease in blood pressure.

Side effects

The main disadvantage to using ACE inhibitors is their potential to cause a hacking cough. Less common side effects include dry mouth, nausea, rash, and on occasion, kidney dysfunction and elevated blood potassium. Very rarely, ACE inhibitors can cause angioedema (0.1% to 0.7% of patients taking ACE inhibitors). Angioedema is a medical emergency where the lips, tongue and throat swell up and interfere with breathing within minutes.

Although ACE inhibitors and ARBs work very similarly, ARBs do NOT cause a cough. Angioedema is also less common with ARBs than with ACE inhibitors. Other side effects of ARBs like headache, nausea, and dry mouth are similar to those of ACE inhibitors.

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