ACE-inhibitor + ARB?

[pinkyrx]

How common is it to see a patient on both an ACEI and an ARB? I thought that generally patients were started on ARB's if they developed a cough with ACEI's?

 

[no-see-um]

How common is it to see a patient on both an ACEI and an ARB? I thought that generally patients were started on ARB's if they developed a cough with ACEI's?

A few studies has patients on both, back in the day... I'd have to look up the names of the trials sometime. it's been done before...

 

[SpirivaSunrise]

Depends who you talk to...I've come across it several times, but most of the time it was duplicate therapy and one was d/c'd when I brought it to the physician's attention. There is a proposed mechanism justifying combined ACEI/ARB...

But like no-see-um mentioned, there have been studies that look into combo treatment...clinically there didn't seem to be much benefit. Here's a decent article that discusses a few of the studies (specifically for HTN):

Combination ACE inhibitors and angiotensin II receptor blockers for hypertension. Finnegan PM, The Annals Of Pharmacotherapy, 2003 Jun; Vol. 37 (6), pp. 886-9.

 

[GatorRxGirl]

I've seen it a couple times.

 

[pinkyrx]

Thanks everybody. I thought it seemed like duplication of therapy but I was wondering if I was missing something.

 

[no-see-um]

Depends who you talk to...I've come across it several times, but most of the time it was duplicate therapy and one was d/c'd when I brought it to the physician's attention. There is a proposed mechanism justifying combined ACEI/ARB...

But like no-see-um mentioned, there have been studies that look into combo treatment...clinically there didn't seem to be much benefit. Here's a decent article that discusses a few of the studies (specifically for HTN):

Combination ACE inhibitors and angiotensin II receptor blockers for hypertension. Finnegan PM, The Annals Of Pharmacotherapy, 2003 Jun; Vol. 37 (6), pp. 886-9.

ur way too diligent 😛

The "CHARM" trial had a subset of patients on diruetic + beta-blocker + digoxin + ACE-I, and one with those 4 meds PLUS an ARB, as well, and noted decreases in 1yr risk for CV death OR CHF hospitalization between the groups. 1 yr mortality, alone, also decreased, but only by a few percentage points between the groups.

There's some evidence (CHARM, and Val-HeFT) that looks at ARBs individually vs ACE-I, and show they're better than starting with Captopril, for instance. That's the direction where studies are going these days. Not combo, but head-to-head. But keep in mind that ACE-I's have generics that cost a lot less.

 

[SpirivaSunrise]

There's some evidence (ELITE, and Val-HeFT) that looks at ARBs individually vs ACE-I, and show they're better than starting with Captopril, for instance. That's the direction where studies are going these days. Not combo, but head-to-head.

Yep! 👍 And then you've got to consider patient populations (i.e. diabetics) and the renal protective effects.

 

[pharmboy30]

there was an article about it on the last medscape newsletter I think...of course I didn't read it 😴

 

[pinkyrx]

there was an article about it on the last medscape newsletter I think...of course I didn't read it 😴

There was an article about it in the December issue of the Pharmacist's Letter too.

 

[njac]

I've seen them used together to combine the beneficial effects and prevent the "ACE escape" with the ARB. I remember CHARM and I've seen it somewhere else as well... I should dig through my renal notes.