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The goal of treating high blood pressure (HBP or hypertension) traditionally has been to reduce the blood pressure to a certain level (e.g., to less than 140/90). More recently, however, it has become apparent that how you lower the blood pressure (that is, what drugs you use) is also important. It seems that the ARB and ACE inhibitor drugs produce added protective effects on the heart, kidneys, and brain. In other words, the protective effects of these classes of drugs on these organs in patients with HBP far exceed the protective effects produced by lowering the blood pressure alone.
Just what added protection do the ARB and ACE inhibitors provide? In the heart, these drugs reduce heart attacks (myocardial infarction), and in the brain, they reduce strokes. In the kidneys, ARB and ACE inhibitors have been shown to reduce proteinuria (loss of protein in the urine), preserve renal (kidney) function, and slow the progression of renal failure, especially in diabetics.
Recently, an ACE inhibitor, ramipril (Altace), received FDA approval for another usage (indication) in addition to treating HBP. This drug is now approved for selected individuals (even without HBP) to reduce their risks for strokes, heart attacks, and death from these cardiovascular diseases. These selected individuals are either over age 55 with a history of cardiovascular disease or have diabetes and at least one other risk factor for cardiovascular disease, such as smoking or elevated blood cholesterol. Previously, ACE inhibitors also were studied in patients (without HBP) with weakened heart muscle (heart failure) following a heart attack. In these studies, the ACE inhibitors were shown to reduce subsequent heart problems (cardiac events) for these patients.
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Furthermore and finally, data are rapidly appearing to support the suggestion that ARB and ACE inhibitor drugs produce several effects that fight cholesterol buildup. This new information, coupled with the above-mentioned protective effects on the brain, heart, and kidneys, is quite exciting. Thus, these two classes of anti-hypertensive drugs appear to provide patients with additional benefits (bonuses, if you will) beyond those provided by just lowering the blood pressure. Whether any one drug in a class is better than any other drug in that class, however, remains to be proven. Accordingly, the choice of a specific drug within each class of drugs is currently most often determined by the drug's price, insurance restrictions, and the doctor's preference.
Medical Author: Dwight
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.