Study: Blood Pressure Meds Work Equally, But One Has Fewer Side Effects

Angiotensin receptor blockers may be less likely to cause side effects than ACE inhibitors.

While patients starting treatment for high blood pressure can benefit equally from two different classes of medicine — angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) — ARBs may be less likely to cause side effects, a new study reveals.

The extensive analysis, based on 3 million patients’ electronic health record and insurance claim databases in the United States, Germany, and South Korea, was published in Hypertension on July 26.

While ACE inhibitors are prescribed more commonly for first time blood-pressure patients, ARBs work just as well and may cause fewer side effects, according to the American Heart Association.

“In professional guidelines, several classes of medications are equally recommended as first-line therapies. With so many medicines to choose from, we felt we could help provide some clarity and guidance to patients and health care professionals,” RuiJun Chen, M.D., lead author of the study and assistant professor in translational data science and informatics at Geisinger Medical Center in Danville, Pa., said in a statement.

"If a patient is starting hypertension therapy for the first time, our results point to starting with the ARB over the ACE inhibitor,” George Hripcsak, M.D., senior author of the study and professor and chair of biomedical informatics at Columbia University Vagelos College of Physicians and Surgeon, said in a statement.

The researchers analyzed health records for patients who began first-time blood pressure-lowering treatment with a single medicine between 1996 and 2018 and compared the occurrence of heart-related events and stroke among nearly 2.3 million patients treated with ACE inhibitors with about 674,000 patients treated with ARBs.

Compared with those taking ARBs, people taking ACE inhibitors were 3.3 times more likely to develop fluid accumulation and swelling of the deeper layers of the skin and mucous membranes, 32% more likely to develop a cough, 32% more likely to develop sudden inflammation of the pancreas, and 18% more likely to develop bleeding in the gastrointestinal tract.

While ARBs may have fewer side effects than ACE inhibitors among those just beginning treatment, “we unfortunately cannot extend these conclusions to people who are already taking ACE inhibitors or those who are taking multiple medications,” Chen said.