Angiotensin Receptor Blockers Versus Angiotensin Converting Enzyme Inhibitors for the Treatment of Arterial Hypertension and the Role of Olmesartan

Abstract

Blood pressure lowering by all classes of antihypertensive drugs is accompanied by significant reductions of stroke and major cardiovascular (CV) events. Drugs acting on the renin–angiotensin–aldosterone system, such as angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), showed similar benefit on major CV events to other antihypertensive medications. In real-world practice, ARBs reduced by 10% the incidence of CV mortality, non-fatal myocardial infarction, non-fatal stroke and provided superior protection against CV events than ACEIs in high-risk patients. Despite similar antihypertensive properties and a favourable safety profile for both ACEIs and ARBs, evidence indicates that patients treated with ARBs have lower rates of withdrawal for adverse events and greater persistence to therapy than those treated with ACEIs. Among ARBs, olmesartan is one of the latest generation compounds introduced in clinical practice for treating hypertension: head-to-head comparative trials suggest that the efficacy of olmesartan is superior to that of commonly prescribed ACEIs (ramipril and perindopril). The drug, administered as a monotherapy or in combination with a dihydropyridine calcium channel blocker or a thiazide diuretic, has proved to be effective in maintaining blood pressure stability over 24 h, with a favourable safety profile and low discontinuation rates. These properties are pivotal for considering olmesartan as a useful antihypertensive agent especially for high-risk patients (e.g. elderly, diabetics, patients with metabolic syndrome).Funding: Article preparation and open access fee were funded by Menarini International Operations Luxembourg S.A. (M.I.O.L.)

Morning hypertension for stroke and cardiovascular: clinical pearls for primary care

“…(19) In a Japanese study, the combination of losartan and hydrochlorothiazide was able to significantly improve blood pressure control compared to high-dose losartan. (50) Another study using a combination of ARB-CCB and ARB-ACEI showed similar results. (50) In several other studies, the increase in morning blood pressure is associated with activation of the sympathetic nervous system and the renin-angiotensin system, therefore several hypotheses suggest the use of drugs that act specifically on this pathway.…”

“…(50) Another study using a combination of ARB-CCB and ARB-ACEI showed similar results. (50) In several other studies, the increase in morning blood pressure is associated with activation of the sympathetic nervous system and the renin-angiotensin system, therefore several hypotheses suggest the use of drugs that act specifically on this pathway. (51,52) However, there have been no studies comparing the potential of each of the antihypertensive drugs separately to lower blood pressure in the morning.…”

Cardiovascular therapeutics: A new potential for anxiety treatment?

“…Differently to ACE inhibitors, ARBs do not stimulate bradykinin production, thus partly avoiding side effects such as cough or angioedema. Similarly to ACE inhibitors, ARBs reduce hemodynamic burden and exert antiremodeling effect 181,200,201 . In the LIFE (Losartan Intervention For Endpoint reduction in hypertension) study with hypertensive patients, losartan exerted regression of left ventricular (LV) hypertrophy and reduction of cardiovascular events 202 .…”

Withholding vs. Continuing Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Before Non-cardiac Surgery in Older Patients: Study Protocol for a Multicenter Randomized Controlled Trial

“…As first line antihypertensive treatment, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) produce arterial vasodilatation and reduce blood pressure through the inhibition of the renin-angiotensin aldosterone system (4). Moreover, the use of ACEIs/ARBs exerts many beneficial effects, including improved cardiovascular and renal outcomes in patients with diabetes, decreased mortality in patients with acute kidney injury, and improvement in symptoms and survival in patients with heart failure with reduced ejection fraction (7)(8)(9)(10).…”