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ACE Inhibitors Save Lives Part 2

Posted Jul 20 2012 3:00am
Think back, if you can, to when it was cooler, at the end of April when a meta-analysis was published in the European Heart Journal suggesting that use of angiotensin converting enzyme (ACE) inhibitors were associated w/decreased all-cause mortality compared to angiotensin 1 receptor blockers (ARBs) & placebo.  Just last week, a meta-analysis was published in the British Medical Journal , in which the authors concluded that use of ACE inhibitors was associated w/lower risk of pneumonia compared to both ARBs & placebo.

So what's the down side?  It turns out that ACE inhibitors give some a dry ticklish cough.  That's when we usually switch over to ARBs which also lower blood pressure & protect the kidneys, but without causing a cough.  The big question then is how much of a side effect are you willing to tolerate given two studies suggesting that ACE inhibitors, but not ARBs, are associated w/lower all-cause mortality and lower risk of pneumonia.  Worse, this being 2012, we have not yet studied enough people for an adequate duration to demonstrate cause & effect.  All we have is associative data linking the two, but nothing demonstrating causality.

Remember that hypertension or high blood pressure is a silent killer.  You won't know it unless your check your blood pressure regularly.  So when treating hypertension, the best that we can hope for w/any medication is one that doesn't cause any side effects even as it lowers blood pressure.  And if the blood pressure lowering medication causes side effects?  We need to search for a suitable alternative.  But what if that side effect was just a dry ticklish cough?  Would you trade your ACE inhibitor for an ARB?  Especially in light of these recent studies?  Something for each of us to ponder . . .
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