Blueberry Pharmacy Analysis of Blood Pressure Treatment
By Greggory Rendine (Duquesne) and Grace Havens (Pitt), PharmD Candidates 2023
ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are prescription medications commonly used for lowering blood pressure. Common ACE inhibitors include lisinopril, enalapril, and quinapril. Common ARBs include olmesartan, losartan, and valsartan. According to blood pressure guidelines, both of these medications are equally effective as a first-choice medication for high blood pressure. Nevertheless, there is some bias towards the use of ACE inhibitors over ARBs. This bias is primarily due to the fact that ACE inhibitors have been around longer, meaning that overall there have been more studies done on ACE inhibitors than ARB medications. As a result, most pharmacies will end up dispensing more ACE inhibitors for patients. However, we are a bit different here at Blueberry Pharmacy!
A recent study has shown a difference in safety between ACE inhibitors and ARBs. Generally, both of these medications share similarities in the side effects that patients experience, but it has been shown that ARBs actually have a better safety profile for long-term medication use. This difference in safety was determined by a study which involved over 3 million patients who are taking either an ACE inhibitor or ARB, for their high blood pressure. The results of this study revealed that ACEi and ARBs were equally effective in lowering blood pressure and preventing heart attacks, heart failure, and strokes. The more interesting findings were that ARBs caused fewer side effects than ACE inhibitors, including cough, GI bleeds, pancreatitis, and swelling. Frequently, patients that switch from an ACE inhibitor to an ARB due to side effects tend to tolerate the ARB. Overall, the results of this study recommend that ARBs should be preferred over ACE inhibitors.
In 7 out of 8 databases used in this study, the majority of patients were on ACE inhibitors except for a South Korean database. At Blueberry Pharmacy, we have filled and dispensed more ARBs than ACE inhibitors. In total, we have 155 unique patients on ARBs compared to 117 patients on ACE inhibitors. Expanding our knowledge of medications is extremely important and helps us provide every patient with the safest and most effective treatment. That is why at Blueberry Pharmacy we try to recommend the prescribing of ARBs over ACE inhibitors. Even though the differences between these two medications may seem minor, it is important to us to share evidence-based recommendations to improve patient outcomes. Welcome to Different!
Link to study mentioned: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16667?cookieSet=1
