“Pithy” Journal Club
Sailesh Harwani
9/25/08
1. Clinical Case
An elderly male with hypertension that reported facial swelling. Stated it had been intermittently ongoing for years and did not remember it occurring prior to starting blood pressure medicine (HCTZ/lisinopril) in 2001. He had been referred to allergy and immunology for this in 2003 and was prescribed Zyrtec with minimal benefit. He had been on lisinopril since 2001 and experienced cough with this intermittently, but did not report this to a clinician until he was an inpatient secondary to a MVA in 2008. At that time switched from lisinopril to losartan. However, he now experienced the same facial swelling he had prior.
2. www.tripdatabase.com
search terms: “ace inhibitors versus arb adverse reactions”
3. A systematic review of 61 clinical studies that compared ACE and ARB in head to head trials in the treatment of essential hypertension in adults (>18 years of age).
RCT: 47; NRCT: 1; Retrospective: 9; Prospective: 2; Cross Sectional: 1;
Case Controlled: 1
The article asked “Whether ACE Inhibitors or ARBs are more effective in treating essential hypertension?” Studies selected for review were controlled for treatment protocols and measures were taken to exclude studies that attempted to compare ACEI and ARBs in the context of different antihypertensive medication profiles.
4. Rationale: ACE Inhibitors and ARBs are amongst the most prescribed medications for hypertension. Clinicians hold these two classes of medications as equivalent int heir clinical efficacy. However, the comparative effectiveness, advantages, and disadvantages of one class of medication over the other is unknown.?
5. The outcomes analyzed to compare ACE I to ARBs were:
1. Blood pressure Control
2. Monotherapy success
3. Death/Major Cardiovascular events
4. Lipid & Glucose Levels
5. Left Ventricular Mass/Function
6. Renal Function
7. Quality of Life/Adverse Events
8. Adherence/Tolerability
Perhaps there is no reason to not use an ARB prior to an ACE. I