Why do we still use ACE Inhibitors?

[IMGUSMLEStep1]

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We all know that ACE Inhibitors cause caugh and angioedema that can be avoided by using ARBs. So why do we still use ACE Inhibitors, and in most cases they are the first line of treatment for HTN and Heart Failure? I would think that they'd become obsolete due to the fact that a better version of these drugs is available. I would really appreciate your feedback. Thanks.

 

[DrTacoElf]

http://formularyjournal.modernmedic...actice-/ArticleStandard/Article/detail/335323

 

[rem6775]

They're cheap? And effective? I take lisinopril and it works just fine for quite cheap.

 

[IM Substance P]

We all know that ACE Inhibitors cause caugh and angioedema that can be avoided by using ARBs. So why do we still use ACE Inhibitors, and in most cases they are the first line of treatment for HTN and Heart Failure? I would think that they'd become obsolete due to the fact that a better version of these drugs is available. I would really appreciate your feedback. Thanks.

The cough is common enough, but angioedema is pretty uncommon.

Moreover, they're extremely cheap, AND they have better prospective data.

The ARB's have most been compared to ACE-I's mostly through non-inferiority trials, so ARB data on cardiovascular mortality, progression of kidney disease, etc. is incomplete.

The pragmatist chooses an ACE-I and switches if a side effect arises. The schmuck who is wooed by some drug rep prescribes the ARB first.

 

[IMGUSMLEStep1]

http://formularyjournal.modernmedic...actice-/ArticleStandard/Article/detail/335323

Thanks for the link, it was very helpful. 🙂

 

[buckeye12]

Thanks for the link, it was very helpful. 🙂

Another thing to consider is that using a specific AT1 blocker like the ARBs increases ATII levels, and since we don't really know the full effects of stimulation of the other angiotensin receptors, we as a result also don't know as much about the possible adverse effects associated with ARBs.

Another example is the Vioxx/Celebrex ordeal. Inhibiting just COX-2 seems better than inhibiting both COX-1 and COX-2, but holistically, it's not.

And you could also consider the treatment of RA -- biologics seem more specific, but they still aren't that much more effective than MTX/plaquenil, even though treatment with biologics costs upwards of 100 times more.

 

[IMGUSMLEStep1]

Another thing to consider is that using a specific AT1 blocker like the ARBs increases ATII levels, and since we don't really know the full effects of stimulation of the other angiotensin receptors, we as a result also don't know as much about the possible adverse effects associated with ARBs.

Another example is the Vioxx/Celebrex ordeal. Inhibiting just COX-2 seems better than inhibiting both COX-1 and COX-2, but holistically, it's not.

And you could also consider the treatment of RA -- biologics seem more specific, but they still aren't that much more effective than MTX/plaquenil, even though treatment with biologics costs upwards of 100 times more.

Thanks.

 

[jad2121]

We all know that ACE Inhibitors cause caugh and angioedema that can be avoided by using ARBs. So why do we still use ACE Inhibitors, and in most cases they are the first line of treatment for HTN and Heart Failure? I would think that they'd become obsolete due to the fact that a better version of these drugs is available. I would really appreciate your feedback. Thanks.

honest answer. ARB's are expensive, ACE inhibitors are cheap.

 

[vicinihil]

I can't imagine everyone that uses ACEI get angioedema and cough. How bad is this cough?

Also, why do you still use Niacin? I think the benefits outweighs the cost.

 

[UAAWolf]

They're cheap? And effective? I take lisinopril and it works just fine for quite cheap.

x2. Linsinopril does not cause me any cough and is more effective than an ARB such as Diovan since ARBS do not increase Bradykinin (which causes dilation in vessels yet also inflammation in lungs thus the occasional cough).


Honestly since I started a low dose of ACE-I I'm a beast in the gym...my veins are out of control and the only thing I've changed is adding lisinopril..

 

[UAAWolf]

The pragmatist chooses an ACE-I and switches if a side effect arises. The schmuck who is wooed by some drug rep prescribes the ARB first.

Excellent post.

All you people claiming side effects...I've had 0 at 20mg/day. My BP was 145/80 (due to stress I'm sure lol) and now 117/65. I once was on atenolol...now THAT drug is pure **** unless you're old. Still can't believe a doctor prescribed it to a 22 yr old with a resting heartrate of 50...