Features July 2008 Issue

ARBs vs. ACE Inhibitors: Which Is Better for Hypertension?

ACE inhibitors are generally preferable, but ARBs offer an effective alternative for patients suffering side effects.

According to the Centers for Disease Control and Prevention, more than half of Americans age 65 and older have high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Prinivil, Zestril) or ramipril (Altace), are commonly used to treat itóbut some estimates suggest that up to 25 percent of patients canít tolerate them. Could an angiotensin II receptor blocker (ARB) such as telmisartan (Micardis) be a useful alternative? A qualified "yes" is the message from the ONTARGET study, which followed 25,620 patients over the age of 55, with heart disease or diabetes (a risk factor for heart disease), for 55 months. The results, published in the March 31 online edition of the New England Journal of Medicine, suggest that telmisartan is just as effective as ramipril.

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