A retrospective, new-user comparative cohort study revealed that angiotensin receptor blockers (ARBs) do not differ statistically significantly in effectiveness at the class level compared with ACE (angiotensin-converting enzyme) inhibitors as first-line treatment for high blood pressure but present a better safety profile. The study included all patients with high blood pressure initiating monotherapy with an ACE inhibitor (n=2 297 881) or ARB (n=673 938) between 1996 and 2018 across 8 databases from the United States, Germany, and South Korea. There was no statistically significant difference in the primary outcomes of acute myocardial infarction (hazard ratio [HR], 1.11 for ACE versus ARB), heart failure (HR, 1.03), stroke (HR, 1.07), or composite cardiovascular events (HR, 1.06). Across secondary and safety outcomes, patients on ARBs had significantly lower risk of angioedema, cough, pancreatitis, and GI bleeding. The findings support preferentially prescribing ARBs over ACE inhibitors when initiating treatment although both classes are guideline-recommended first-line treatments for high blood pressure. Source: https://www.ahajournals.org/
