ACE Inhibitors versus ARBs in Heart Failure: The Evidence and Treatment Considerations

 Abstract

ACE inhibitors have been a primary therapy in the prevention and treatment of systolic HF for more than a decade while Angiotensin receptor blockers (ARBs) are a valuable option to reduce cardiovascular (CV) mortality and morbidity in cardiac patients in whom ACE-inhibitors (ACE-Is) cannot be used. However, clinical outcome data from direct comparisons between ACE-Is and ARBs are scarce, and some data have recently suggested superiority of ACE-Is over ARBs.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) play a role in the treatment of heart failure (HF). The literature shows that in patients with HTN with comorbidities, such as HF, myocardial infarction (MI), diabetes mellitus, ACE inhibitors and ARBs appear to provide added benefit beyond solely lowering blood pressure.

There have been numerous clinical trials looking at the use of ACE inhibitors and ARBs in HF. Overall, it has been noted that ACE inhibitors and ARBs appear to have an additional benefit beyond just the blood pressure-lowering effect when used in certain populations. When compared to each other in head-to-head trials, ACE inhibitors and ARBs generally appear to demonstrate no difference in primary outcomes. With regard to side effect profiles, ARBs do tend to be better tolerated than ACE inhibitors. While ACE inhibitors and ARBs may increase initial medical costs, over time they may prove to be very cost-effective. Generally, either ACE inhibitors or ARBs may be selected in the treatment of HF, and the deciding factor may be largely patient-specific.

Biography

Syed Raza is graduated from Aligarh University in India in 1993. After completing his postgraduate degree in Medicine from the same university, he moved to the UK for higher specialist studies. He successfully completed MRCP and CCT and later also awarded Fellow of the Royal College of Physicians of Edinburgh. He was awarded Professor John Goodwin prize for outstanding performance in Diploma Cardiology exam at Hammersmith Hospital, University of London in 2001. Raza is Fellow of American College of Cardiology   American College of Chest Physicians as well as Fellow of European Society of Cardiology.  He is also on the committee of Acute Cardiovascular Care.  Heart Failure and Cardiovascular Imaging (European Society of Cardiology).

2^nd Edition of International Conference on Hypertension and Cardiovascular Diseases webinar, October 05-06, 2020.

Abstract Citation:

Syed Raza is a consultant in Cardiology and Head of the department of Medicine at Awali Hospital, Bahrain.– ACE Inhibitors versus ARBs in Heart Failure: The Evidence and Treatment Considerations Hypertension & CVD 2020, 2^nd Edition of International Conference on Hypertension and Cardiovascular Diseases, webinar October 05-06, 2020