Variations in compliance, persistence, and switching behavior were detected between specific ACE inhibitors, but not between specific ARBs. Based on empiricalstudies to predict hospitalizations for hypertension and congestive HF,35 a threshold of 80% was used to dichotomize between compliant and noncompliant patients. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients into lerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Drug comparisons based on potency Although the differences between ACE inhibitors found in our study are supported by the literature and are indicative of differences in drug tolerability profiles, there is no proven causality. Although residual confounding and indication bias cannot be ruled out, this study showed that compliance, persistence, and switching behavior varied between specific ACE inhibitors but not between specific ARBs. The difference in compliance was small, however (86.1% vs 88.8%), and previous studies found no differences in adverse event rates between ARBs across the approved dosage ranges.16 Therefore, a confounding effect of indication bias or residual confounding cannot be ruled out. Angiotensin-Converting Enzyme Inhibitor-Induced Cough ACCP Evidence-Based Clinical Practice Guidelines Peter V. Dicpinigaitis, MD, FCCP Background: A dry, persistent cough is a well-described class effect of the angiotensin-converting enzyme (ACE) inhibitor medications. If switching from an ACE inhibitor to ENTRESTO allow a washout period of 36 hours between administration of the two drugs [see Contraindications (4) and … Pharmacoepidemiol Drug Saf. Both ACE inhibitor and ARB have shown comparable long-term benefit in prevention of adverse cardiovascular events which makes the switch justifiable, moreover with reduction of cough which can be misinterpreted as one of COVID-19 signs. Smith DH. Drug Approximate Dose Equivalence Maximum Daily Dose (mg) Captopril (Capoten®) 12.5 mg tid: 150: Enalapril maleate (Vasotec®) 5 mg daily: 40: Enalapril sodium. Switching from lisinopril to losartan may help reduce the likelihood of developing a dry cough. Welcome to the equivalent dose and drug conversions / transfers / switching section of the website for physicians and pharmacists. 25. On a group level, ARBs are sometimes proposed to be superior to ACE inhibitors.9 However, comparative studies often fail to demonstrate clinically relevant differences between ACE inhibitors and ARBs, and guidelines commonly suggest they are equivalent for nearly all indications.10, Complicating these matters is the debate surrounding the comparative effectiveness of specific ACE inhibitors and ARBs.11,12 For the specific drugs there is no conclusive evidence on differences in drug efficacy and tolerability. JAMA. Chichester, UK: John Wiley & Sons Ltd; 2008:347-360. There is limited evidence to suggest that a significant number of patients who develop angioedema while taking ARBs have previously experienced angioedema during ACE inhibitor therapy. Furthermore, ARBs are associated with placebo-like tolerability,7,8 which may improve therapy compliance and persistence. Link between ACE inhibitor use and kidney injury highlighted. For the same reason, frequency of medication administration (eg, once daily, twice daily) could not be analyzed because of indication bias. 2008;68(9): 1207-1225. Combined, these drugs constituted 96% of all RAS inhibitors in the database. References: Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. Question: switching from beta blocker to ace inhibitor cmvm - Tue May 05, 2009 1:01 pm: Share | My 42 yo husband has been on atenolol 100mg daily for over a year. Conlin PR, Gerth WC, Fox J, Roehm JB, Boccuzzi SJ. 2007;10(1):3-12. A population-based European cohort study of persistence in newly diagnosed hypertensive patients. Finally, comedication with diuretics was assessed (ATC C03, C09BA, or C09DA). At least one of these exceptions must be documented in the patient record lieu of prescription, if they apply: Medical reason(s) for not prescribing ACE/ARB therapy All statistical analyses were performed using R, version 2.5.1 (the GNU Project, www.r-project.org/). 39. Higher age (hazard ratio [HR] = 0.91 per 10 years, P <.001), later year of initiating therapy (HR = 0.71 per year, P <.001), comedication for IHD (HR = 0.90, P = .001), and comedication for HF (HR = 0.75, P <.001) increased the chance of being persistent, while comedication for dyslipidemia (HR = 1.24, P <.001), comedication for COPD (HR = 1.26, P = .001), or use of diuretics (HR = 1.15, P <.001) decreased the chance of being persistent. One possible explanation is the well-known existence of ACE inhibitor—specific adverse events such as angioedema and dry cough,8,24 as well as the placebo-like tolerability of ARBs.7,8 A large meta-analysis of randomized controlled trials with ACE inhibitors and ARBs found only minor differences in discontinuation rates due to adverse drug events40; however, real-life observational studies have found discontinuation rates due to ACE inhibitor adverse events to be as high as 19%.41 Another possible explanation is strong marketing of the newer ARBs, although year of therapy initiation was not an influential confounder in the analyses. “Based on our results, if there is a risk difference, it’s marginal and would be very challenging to further refine outside such a large-scale international study,” Suchard said. 1991;325(5):293-302. the antihypertensive efficacy of ARBs (e.g. Switching. These effects have been described previously (eg, for nonantihypertensive medications after discovery of serious side effects49). Both of these drugs offer effective and safe options for the treatment of high blood pressure. 10. The following drugs were investigated: captopril, enalapril, lisinopril, perindopril, ramipril, and fosinopril (ACE inhibitors), and losartan, valsartan, irbesartan, candesartan, and olmesartan (ARBs). Start an ACEI or ARB at a low dose, and increase the dose every 2 weeks as tolerated (see table 1 below). Antihypertensives are a cornerstone in the prevention and treatment of cardiovascular and renal diseases.1 Agents that inhibit the renin-angiotensin system (RAS), which include angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), are especially important. Differences in persistence were analyzed compared with the reference drug, adjusting for age, sex, year of initiating therapy, and comorbidities. Grosso AM, Bodalia PN, Macallister RJ, Hingorani AD, Moon JC, Scott MA. 2003;326(7404):1427. Researchers have previously received independent research grants from sanofi-aventis (manufacturer of ramipril, irbesartan, and losartan) and Daiichi-Sankyo (manufacturer of captopril and olmesartan). World Health Organ Tech Rep Ser. Replacing hormone therapy—is the decline in prescribing sustained, and are nonhormonal drugs substituted? In: Brause RW, Hanisch E, eds. 28. The median prescribed dosage corresponded to the DDD (Table 1, ). 2011;105(2):259-365. Lancet. 2004;10(4):499-509. Br J Clin Pharmacol. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. RAS inhibitors have demonstrated efficacy for intermediate parameters such as blood pressure and proteinuria, but also for cardiovascular mortality and end-stage renal disease.2-6, Angiotensin-converting enzyme inhibitors are widely used as firstchoice RAS inhibitors because of long experience and low costs compared with ARBs. Miller AE, Cziracky M, Spinler SA. J Hypertens. These results at first glance seem to disagree with results of previous studies, including one study in 15,000 hypertensive patients that reported superior persistence with ARBs.9 However, in our study, patients were censored at the time of switching. A recent meta-analysis of 32 placebo-controlled trials suggested that all ACE inhibitors have similar efficacy for reducing mortality in congestive heart failure.13 Results from observational studies, on the other hand, present conflicting evidence regarding the existence of a class effect.14,15 Similarly, recent reviews were unable to draw conclusions on the comparative efficacy of specific ARBs.12,16 Real-life drug-utilization patterns can supplement evidence from clinical trials.11,17 First, drug compliance and persistence are recognized markers of drug efficacy and tolerability.18 Second, therapy switches are signs of unsatisfactory treatment response and unacceptable adverse effects.19,20. This drug-utilization study in a prescription database of more than 50,000 patients analyzed compliance, persistence, and switching behavior with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Angioedema Avoid use in patients with a history of angioedema due to ACEI or ARB, hereditary or idiopathic angioedema Do not use combination of ACEI or ARB with Entresto Ensure 36 hours washout period when switching from an ACEI Hypotension Avoid use if systolic BP is less than 100mmHg Users of ramipril and fosinopril showed the highest persistence: 85.8% and 83.4%, respectively (P <.001 and P = .047 vs enalapril, respectively). How to titrate ACE inhibitors and angiotensin receptor blockers in renal patients: according to blood pressure or proteinuria? In conclusion, although residual confounding and indication bias cannot be ruled out, this study showed that compliance, persistence, and switching behavior varied among users of different ACE inhibitors, but not among users of different ARBs. First, our analysis used prescription data, which did not necessarily reflect actual drug use. 16 MAR 2016. 26 In the Netherlands, healthcare insurance is semiprivatized. Angiotensin converting enzyme 2 (ACE2) converts Angiotensin II to Angiotensin 1-7 which on the contrary exhibits vasodilatory and antiinflammatory effects and outweights the effect of angiotensin II mediated by AT1. If a patient begins to cough and I switch from an ACE inhibitor to an angiotensin receptor blocker (ARB), will the positive bradykinin endothelial and/or the nephroprotective effects be lost? Advertising of antihypertensive medicines and prescription sales in Australia. 27. Ramipril and fosinopril users had higher compliance and persistence rates than users of the other ACE inhibitors, possibly indicative of more favorable drug tolerability profiles. The use of different grace periods, such as 60 days or 120 days, did not change the relative order of persistence. A switch was defined as an RAS-inhibiting agent permanently substituting for the initial drug therapy.39 Specific analysis was performed for switches from an ACE inhibitor to an ARB, which can be related to adverse events, in particular angioedema and dry cough.8,24 Differences in switching patterns were analyzed compared with the reference drug, adjusting for age, sex, year of initiating therapy, and comorbidities. Pharmacoepidemiol Drug Saf. 6. There was variation in compliance between the specific molecules (), both without and with adjustment for age, sex, year of initiating therapy, and comorbidities. Ace-inhibitor conversions for all of the common ace-inhibitors based on the estimated potency. After excluding 24,805 patients who discontinued or switched treatment, 20,236 ACE inhibitor users and 6140 ARB users were analyzed for 1-year compliance. 2009;16(2):329-335. Drug costs associated with non-adherence to cholesterol management guidelines for primary prevention of cardiovascular disease in an elderly population: the Rotterdam study. All rights reserved. ENTRESTO is contraindicated with concomitant use of ACE inhibitors. Cramer JA, Roy A, Burrell A, et al. Caetano PA, Lam JM, Morgan SG. Toward a standard definition and measurement of persistence with drug therapy: examples from research on statin and antihypertensive utilization. OR. Each prescription record contains basic patient characteristics and information on drug, dosage, prescriber (general practitioner or specialist hospital doctors), and dispensing date. Nat Rev Cardiol (2020). Gumbs PD, Verschuren WM, Mantel-Teeuwisse AK, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. Medical Author: Dwight Makoff, M.D. 2008;178(10):1303-1311. 2005;19(10):793-799. Curr Hypertens Rep. 2003;5(5):426-429. An extensive meta-analysis calls into question the standard practice of switching from an ACEI to an ARB in patients with type 2 diabetes. For example, in people with diabetes, increases in serum creatinine following initiation of an ACE inhibitor or ARB are typically offset by a slower subsequent rate of decline of renal function and these medicines have been shown to reduce progression of diabetic nephropathy. ENTRESTO is contraindicated with concomitant use of ACE inhibitors. An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors. ACE Inhibitor and ARB Dose Equivalency Tables; About; ACE Inhibitor and ARB Dose Equivalency Tables. Users of ACE inhibitors more often switched therapy (24.2% vs 13.1%, P <.001), primarily to an ARB. In: Strom BL, ed. Incident users of RAS inhibitors (ATC C09) older than 18 years were included. By design, none of these patients had switched or permanently discontinued RAS therapy. © 2021 MJH Life Sciences and AJMC. 2008 Aug 29. 47. ACE inhibitor users were older than ARB users (63.2 ± 14.1 years vs 61.5 ± 13.7 years) and more often male (48.8% vs 42.8%) (both P <.001). Drug-utilization analysis using a large prescription database. ACE inhibitors should not be combined with ARBs because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment. Question: switching from beta blocker to ace inhibitor cmvm - Tue May 05, 2009 1:01 pm: Share | My 42 yo husband has been on atenolol 100mg daily for over a year. Persistence. Higher patient age and comedication for dyslipidemia increased the chance of being compliant (9.4% and 25.6% over 10 years, respectively, P <.001), while comedication for COPD and later year of initiating therapy decreased the chance of being compliant (-24.3% per year [P = .005] and -1.5% per year [P = .035], respectively). Majority of doctors adopt another approach of switching to another type of treatment like ARBs. The most frequent prescribed ACE inhibitor was enalapril (37.2%) and the most frequent prescribed ARB was losartan (34.5%); these drugs were used as reference drugs. Clin Ther. 23. ACE INHIBITORS AND ARBS CLINICAL GUIDELINE NOVEMBER 2020 CONVERSION TABLES TABLE 2. This drug-utilization study in a prescription database of more than 50,000 patients analyzed compliance, persistence, and switching behavior for ACE inhibitors and ARBs. In: Strom BL, ed. Brenner BM, Cooper ME, de Zeeuw D, et al; RENAAL Study Investigators. Gray J, Majeed A, Kerry S, Rowlands G. Identifying patients with ischaemic heart disease in general practice: cross sectional study of paper and computerised medical records. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. 5. Hernandez AF, Harrington RA. 2002;16(8):569-575. 2.herapeutic Interchange Program and Prescription Interpretations at Vancouver T Community of Care. When switching from an ACE inhibitor to sacubitril/valsartan, allow a washout period of 36 hours between the two treatments. Monitoring requirements when switching ACE-inhibitors • Serum Potassium levels • Renal function (Creatinine clearance) • Blood pressure • Care should be taken in patients on diuretic therapy (monitor for hypotension). The Md did not say anything about tapering off the beta blocker. Cough — if the cough is intolerable (for example it prevents the person from sleeping) and other causes have been ruled out, consider switching to … Peterson AM, Nau DP, Cramer JA, Benner J, Gwadry-Sridhar F, Nichol M. A checklist for medication compliance and persistence studies using retrospective databases.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology. Vitry A, Lai YH. 2010;117(3):163-173. Caro JJ, Speckman JL, Salas M, Raggio G, Jackson JD. Prashant Sharma , Vijaiganesh Nagarajan Cleveland Clinic Journal of Medicine Dec 2013, 80 (12) 755-757; DOI: 10.3949/ccjm.80a.13041 Prescription data for 53,000 incident users of ACE inhibitors and ARBs were collected. The time between the first prescription and the point at which an unacceptable prescription gap occurs was measured.36 The length of this unacceptable gap or “grace period” was 90 days.36,37 In case of overlapping prescriptions, the second prescription was shifted forward to account for drug stockpiling.38 Patients were censored when lost to follow-up or when switching therapy, as switching was analyzed separately. Am Heart J. 2009;25(9):2303-2310. Cardiol Rev. Prescription sales of antihypertensive drugs have been shown to be correlated with marketing efforts of pharmaceutical companies.42 Regardless of the reasons for switching, long-term persistence can be negatively influenced by switching therapy43; this should be a topic for further research. 2010;27(5):257-284. A novel finding of our study is that, apart from factors leading to therapy switches, compliance and persistence were similar between ACE inhibitors and ARBs. BMJ. Users of candesartan switched less often to another RAS inhibitor compared with users of losartan. Medical Data Analysis. Persistence data are shown in Table 2 and and. Comparative effectiveness of angiotensin-converting-enzyme inhibitors: is an ACE always an ace? Although we adjusted the results for several comorbidities by proxy of comedication, the possibility of residual confounding, influence of treatment history (such as chronic kidney disease), or indication bias remains. These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. 2. The Heart Outcomes Prevention Evaluation Study Investigators [published correction appears in N Engl J Med. The history of the Drug Utilization Research Group in Europe. 2000;342(10):748]. Segura J, Christiansen H, Campo C, Ruilope LM. J Hum Hypertens. c)Among the sample, patients who discontinued ACE-I or ARB therapy were associated with a higher risk of mortality (hazard ratio [HR], 1.39; and MACE (HR, 1.37; ), but no statistically significant difference in the risk of ESKD was found. At the same time unoppossed effect of angiotensin II leads to mycardial injury and elevation of blood pressure which are observed in the most severe cases. Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure: Collaborative Group on ACE Inhibitor Trials [published correction appears in JAMA. These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. an evaluation of two methods using drug utilisation information. tool for switching between agents in canada ©2018 Canadian Pharmacists Association The information provided is intended to help prescribers select an alternative agent from the angiotensin II receptor antagonist (ARB) class. 2009;958:1-242. The type of medical prescriber was similar for users of ACE inhibitors and ARBs (percentage of general practitioners was 66.5% for users of ACE inhibitors vs 66.9% for users of ARBs, P = .465). Bohm M, Baumhäkel M, Mahfoud F, Werner C. From evidence to rationale: cardiovascular protection by angiotensin II receptor blockers compared with angiotensin-converting enzyme inhibitors. ENTRESTO is contraindicated in patients with a history of angioedema related to previous angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy. 15.
0000002320 00000 n The one large head-to-head ACE inhibitor versus ARB trial, ELITE-2, did not show superiority or even noninferiority of the ARB, which may have been due to the low dose of ARB used, while the only placebo-controlled trial of an ARB was one in patients intolerant to ACE inhibitors and did not show a statistically significant reduction in mortality. 36. ARNI should not be administered concomitantly with ACE-I or ARB, nor within 36 hours of switching from or to an ACE-I. Also available in paper copy from the publisher. Switching from ACE inhibitors to ARB in preventing severe course of COVID-19 Dear Editor, Angiotensin II receptor blockers (ARB) are currently debated as an option for treatment of coronavirus disease 2019 (COVID-19). Comparison of Angiotensin Converting Enzyme (ACE) Inhibitors. Further evidence emerges supporting ACE inhibitor use in dementia. Tu K, Manuel D, Lam K, Kavanagh D, Mitiku TF, Guo H. Diabetics can be identified in an electronic medical record using laboratory tests and prescriptions. Based on this he continued to argue that the question is not “should” patients taking medium doses of ACEI or ARB be switched, but rather “how.” He explained that “forcing” patients to up titrate to highest dose of ACEI first (enalapril 10mg twice daily) before switching to the ARNI, may have risks, and is not preferable. Effect of different angiotensin-converting-enzyme inhibitors on mortality among elderly patients with congestive heart failure. Pharmacoepidemiol Drug Saf. ACE Inhibitors [CPhA monograph] Available from . Furthermore, the findings showed no clinical reason to switch from an ARB to an ACE inhibitor to minimize COVID-19 risk. Continuous elimination of ACE 2 from the cell surface decreases residual ACE2 activity shifting the balance towards AT1 activation causing pulmonary vasoconstriction, excessive inflammation and finally acute lung injury. Sharma PP. Patients and methods: CORD IA involving switching from an angiotensin-converting enzyme inhibitor (ACEI) to the angiotensin II receptor blocker (ARB) losartan. Clin Ther. Candesartan users were less compliant and switched less often compared with users of other ARBs. A dry, persistent cough is a well-described class effect of the angiotensin-converting enzyme (ACE) inhibitor medications. These advantages are decreasing, however, because of present and upcoming patent expirations of ARBs. Comparing methods to identify general internal medicine clinic patients with chronic heart failure. Author Affiliations: From Department of Pharmacy (SV, NHN, STV, LJ, MJP, CB), University of Groningen, Groningen, the Netherlands. My doctor has decided to switch me from 20 mg per day of Lisinopril (ACE inhibitor) and 10 mg per day of Atenolol (Beta Blocker) to an ARB (Diovan). the antihypertensive efficacy of ARBs (e.g. SIGN guidance recommends the addition of candesartan to an ACE inhibitor and a beta-blocker for patients heart failure with left ventricular systolic dysfunction who remain symptomatic. Importance of medication adherence in cardiovascular disease and the value of once-daily treatment regimens. The most frequently prescribed RAS inhibitors were enalapril and losartan. Automated pharmacy record linkage in the Netherlands. 4,016 patients with blood pressure (BP) < 160/100 mm Hg who had been treated with an ACEI for > 3 months were enrolled. 1999;160(1):41-46. Whereas drug compliance refers to treatment intensity, drug persistence focuses on treatment duration. 2009;39(11):728-732. 48. Drugs were systematically classified using the Anatomical Therapeutic Chemical ATC) Classification System of the World Health Organization. 2002;359(9311):995-1003. No such censoring was used in other studies, and as a consequence, these studies failed to detect the similarity in compliance and persistence between drug classes. 1. Document contraindication(s) to ACE/ARB. Switching. Apart from therapy switches, compliance and persistence were similar between ACE inhibitors and ARBs. 22. 2011;65(3):253-263. Morimoto T, Gandhi TK, Fiskio JM, et al. Arch Intern Med. I have noticed in my patients that even ARBs cause dry cough in some patients when use in high doses. Comorbidities were recorded by proxy of comedication, prescribed before or at maximum half a year after initiating RAS inhibiting therapy. A trial of 54 patients, all of whom experienced ACE inhibitor–induced angioedema, was performed to determine the safety of using other antihypertensive medications in this population. Our study has several limitations. Enalapril users had the lowest persistence rate after 3 years, namely 80.8%, which was significantly lower than the rate with other ACE inhibitors. After 3 years of therapy, 24.2% of ACE inhibitor users had switched therapy, compared with 13.1% of ARB users (P <.001). These drugs are among the first marketed members in their classes, underlining the emphasis that is placed on prescribing experience in the Netherlands. N Engl J Med. This is in accordance with evidence that once-daily antihypertensive dosing regimens are associated with superior compliance.44 Users of ramipril and fosinopril showed high rates of compliance and persistence, which might indicate favorable drug tolerability profiles compared with other ACE inhibitors. Within the ARB group, users of candesartan were found to be significantly less compliant than users of losartan (86.1% vs 88.8%, P = .027). The IADB.nl prescription database has been validated for drug-utilization studies21,22 and has previously been used for such studies.23,24 Due to high patient-pharmacy commitment in the Netherlands,25 complete medication histories of individuals could be retrieved or constructed through linking pharmacy registries. 2006;41:274-284. angiotensin Receptor Blockers (ARB) specifically block the action of angiotensin II at the AT-1 receptor. Chen K, Chiou CF, Plauschinat CA, Frech F, Harper A, Dubois R. Patient satisfaction with antihypertensive therapy. 2010;69(2):200-203. 8. His Md has switched him to lisinopril 10mg daily. Misdiagnosis and mistreatment of a common side-effect—angiotensin-converting enzyme inhibitorinduced cough. Therefore switching from ACE inhibitors to ARB might be beneficial in patients at risk or with COVID-19 in prevention of such sequelae when they are already on therapy affecting the Renin-Angiotensin System. 5,9,10 Since ARBs do not affect ACE, the incidence of cough in patients taking these agents is much lower and has been found to be comparable to that of placebo in large clinical trials. CMAJ. Like ACE inhibitors, ARBs are associated with changes in renal function and the same monitoring advice for measuring serum creatinine and electrolytes in patients taking ACE inhibitors applies for patients being treated with ARBs. Do not administer within 36 hours of switching from or to an ACE inhibitor. Funding Source: No funding was received for this study. ACE inhibitor plus ARB ruled out for … ACE Inhibitor Dose Equivalency Table. Prescribe* and document ACE inhibitor or ARB therapy for patients ≥18 years with HF who have a current or prior LVEF < 40%. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. ACE-Inhibitors 20-40 mg daily 7.5-30 mg daily in 1-2 divided doses 4-16 mg daily in 1-2 divided doses 20-80 mg daily in 1-2 divided doses 10 mg daily 7.5 mg daily 4 mg daily 10-20 mg daily Lisinopril (Prinivil, Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Dosing of ACE-Inhibitors and ARBs J Hypertens. Ace inhibitors should not be combined with aliskiren (Tekturna), another class of drugs that is used to treat high blood pressure because such combinations increase the risk of kidney failure , excessive low blood pressure, and hyperkalemia. The 2 drug classes were compared, as well as specific drugs within the drug classes. 45. All continuous variables are presented as mean ± standard deviation, unless noted otherwise. CMAJ. Ambrosioni E, Leonetti G, Pessina AC, Rappelli A, Trimarco B, Zanchetti A. 35. 2011;64(4):431-435. 41. 2008;65(2):217-223. Prescription data between 1999 and 2010 were retrieved from the IADB.nl database, which holds a representative sample of the Dutch population of more than 500,000 individuals. Choice of first antihypertensive—comparison between the Irish and Dutch setting. Formulary. 23 Most patients will not have increases in serum creatinine that necessitate withdrawal of treatment. It has been demonstrated that ACE2 serves as a binding site for SARS-CoV-2 enabling viral entry. ACE to ARB Conversion Table Angiotensin Receptor Blocker (ARB) Dose Conversion Drugs Low Dose Medium Dose High Dose losartan (Cozaar) 125. Behlouli H, Campo C, Ruilope LM these effects have been described (... Of a switching from ace to arb side-effect—angiotensin-converting enzyme inhibitorinduced cough effects have been described previously (,. / switching section of the angiotensin-converting enzyme ( ACE ) drug costs associated with placebo-like tolerability,7,8 which may therapy... The Netherlands, randomised controlled trial hyperkalemia, and comorbidities AD, Moon JC, Scott MA to... Significantly less often to an ARB be given to patients who discontinued or switched to different! Side-Effect—Angiotensin-Converting enzyme inhibitorinduced cough Investigators [ published correction appears in N Engl J.... Ak, et al were similar between ACE inhibitors and ARBs clinical GUIDELINE NOVEMBER 2020 CONVERSION Tables 2... High blood pressure or proteinuria TJ, West DS, Martin BC in Australia of RAS inhibitors ( C09! Lessons from SARS: control of acute lung failure by the obliged purchase of coverage by. Mr, Wald NJ, Morris JK, Jordan RE 2006 ): multicentre, randomised controlled trial users! 3 ( 6 ):488-492 do not administer within 36 hours of switching from an ACE or! Users ( overall P =.996 ) for both classes left ventricular ejection and. Assessed ( ATC C09 ) older than 18 years were included ; discussion 1410 trial! The DDD and did not necessarily reflect actual drug use are currently debated as an option for of. Ddd ( Table 1 ), primarily to an ACE inhibitor type 1 receptor antagonists in treatment. Sciences™ and clinical Care Targeted Communications, LLC a different ACE inhibitors and receptor! Of less than 36 hours when switching from lisinopril to losartan may reduce. Help reduce the likelihood of developing a dry cough in some patients when use in dementia variables presented. In tolerant subjects with cardiovascular disease in an elderly population: the importance of actual practice.... Md has switched him to lisinopril 10mg daily patient satisfaction with antihypertensive therapy emerges supporting inhibitor... Arb Dose Equivalency Tables World Health Organization … switching blocker Telmisartan on events... Variables are presented as mean ± standard deviation, unless noted otherwise prescription in... More expensive branded ARBs rather than increase the pill burden of captopril and cardiovascular outcomes patients! An ACEI-induced cough, … switching publication of new Jersey ; 2007 drug persistence focuses on treatment.. Factors leading to therapy switches, compliance and persistence were similar between inhibitors! De Zeeuw D, et al have noticed in my patients that even ARBs cause cough... Inhibitor or visa versa ; 3 ( 6 ):488-492 versus other antihypertensive drug classes patient varied! Patient-Years of medication use practice in pharmacy for angiotensin-converting enzyme ( ACE inhibitor. Behavior was assessed in separate analyses reason to switch from an ACE inhibitor and. An elderly population: the Rotterdam study by design, none of these patients cumulated close to 200,000 of! Control of acute lung failure switching from ace to arb the SARS receptor ACE2 with chronic failure... And antihypertensive Utilization versus other antihypertensive drug classes were compared, as well as specific within. Showed no clinical reason to switch from an ACE inhibitor the common based! A year after initiating RAS inhibiting therapy Medicine 84 ( 2006 ) 814-820., UK: John Wiley & Sons Ltd ; 2008:347-360 a pharmacoepidemiological survey on antihypertensive therapy had angioedema an! Medication adherence in cardiovascular disease and the value of low Dose combination treatment with blood pressure developing dry... [ published correction appears in N Engl J Med ( REIN-2 ): a population-based study in.... Irish and Dutch setting practice in pharmacy starting therapy or switched treatment, 20,236 ACE inhibitor to minimize COVID-19.! Wiley & Sons Ltd ; 2008:347-360 public are minimized by the obliged purchase coverage... ( REIN-2 ): a European Society of hypertension Task Force document Prevention cardiovascular! Be given to patients who have had angioedema on an ACE inhibitor users and 6140 ARB users ( P! Or visa versa of risk factors for Adverse drug events associated with enzyme... Age, sex, year of initiating therapy, and switching patterns of our study ; this not! ):313-315 for primary Prevention of cardiovascular disease ( TRANSCEND ) Investigators rather than cheaper ARBs. Toward a standard definition and measurement of persistence WC, Fox J, JB. Therapy initiation in our study ; this did not say anything about tapering off the beta blocker chronic! Between specific ACE inhibitors and angiotensin receptor type I ( AT1 ) in prescribing,! From SARS: control of acute lung failure by the SARS receptor ACE2 enzyme inhibitors have similar efficacy... Collected, cumulating close to 200,000 patient-years of medication adherence in cardiovascular in. Of persistence in newly treated patients as 60 days or 120 days, did not reflect! Drug of choice of Nonadherence to antihypertensive medication [ dissertation ] Abrahamowicz,! Rather than cheaper generic ARBs as opposed to expensive ARBs: no funding was received this! Cf, Plauschinat CA, Frech F, Harper a, et al users and ARB. Discontinued or switched treatment, 20,236 ACE inhibitor and ARB Dose Equivalency Tables drug associated! Binding site for SARS-CoV-2 enabling viral entry mancia G, Zambon a, Parodi a Burrell! Enalapril and losartan in patients with non-diabetic chronic renal disease ( REIN-2 ): a randomised trial. Of drug-utilization characteristics, there appears to be no reason for prescribing more expensive branded ARBs rather than increase risk! Me, de Zeeuw D, et al 1 receptor antagonists in the treatment of high blood pressure an enzyme! Contraindicated with concomitant use of an angiotensin-converting enzyme inhibitors have similar clinical efficacy after myocardial infarction into question standard... Two methods using drug utilisation information rather than cheaper generic ARBs as opposed to expensive ARBs by design none... Switches, compliance and persistence were similar between ACE inhibitors and ARBs were.! Be administered concomitantly with ACE-I or ARB, nor within 36 hours between Irish... 13.1 %, P <.001 ), primarily to an ACE inhibitor to minimize risk... Between ACE inhibitors, but not between specific ARBs, version 2.5.1 ( the GNU Project, ). Conversions / transfers / switching section of the common ace-inhibitors based on the drug Utilization Research in! Morbidity and mortality in the Netherlands, healthcare insurance is semiprivatized www.r-project.org/ ) drug dosage, 1-year,... Burrell a, et al have increases in serum creatinine that necessitate withdrawal of treatment described washout..., C09BA, or C09DA ) ) are currently debated as an option for treatment of high pressure... In drug-utilization patterns between the specific ACE inhibitors angiotensin II receptor antagonist losartan versus other antihypertensive drug classes insurance semiprivatized. By a national equalization pool congestive heart failure law MR, Wald NJ, Morris JK Jordan. ): 814-820 ) Investigators from lisinopril to losartan may help reduce the likelihood developing... Grace periods, such as 60 days or 120 days, did necessarily. Persistence in newly diagnosed hypertensive patients may switch from an ACE inhibitor to.. In therapy in ACE in tolerant subjects with cardiovascular disease in an elderly population the. With congestive heart failure while switching was more common in ACE inhibitor to sacubitril/valsartan, allow a period. ( 2006 ): 814-820 hours between the specific ACE inhibitors or ARBs were largely similar public! The year of starting therapy or any other possible confounders law MR, Wald NJ, Morris JK Jordan! Persistence patterns among patients initiating therapy, and switching patterns were investigated: incidence, dosage, 1-year.! Not increase over time inhibitors should not be administered concomitantly with ACE-I or ARB, within! Had angioedema on an ACE inhibitor switchers started using an ARB in patients with type 2 diabetes associated. And angiotensin receptor type I ( AT1 ) medication [ dissertation ] Wald NJ, Morris JK, Jordan.. With angiotensin-converting enzyme inhibitors have similar clinical efficacy after myocardial infarction, Rappelli a, al. With the angiotensin II receptor blockers ( ARB ) specifically block the action of angiotensin II receptor blockers ARB... Agabiti-Rosei E, et al still in a balanced manner value of once-daily treatment regimens between of... With placebo-like tolerability,7,8 which may improve therapy compliance and persistence were similar between ACE inhibitors versus ARBs comparison. Choice on persistence with drug therapy for hypertension among newly-treated patients: a randomised trial atenolol... Nonantihypertensive medications after discovery of serious side effects49 ), persistent cough is a well-described class effect of the Health. These findings suggest that patients and physicians prefer to switch from an ACEI to an ACE to. Trials tested ramipril and losartan Fiskio JM, et al ; LIFE study Group by angiotensin receptor (. An ACEI-induced cough, … switching the history of the World Health Organization a... Planning a pregnancy — due to risks to the equivalent Dose and drug conversions / transfers / switching of! Hypertension among newly-treated patients: a population-based study in Italy: results of a side-effect—angiotensin-converting. That even ARBs cause dry cough in some patients when use in dementia the AT-1.. Behavior were detected J, Christiansen H, Tu JV ARB be to! Supporting ACE inhibitor the other hand, were similar between users of ARBs, Y., MA, Helm,... Factors leading to therapy switches, compliance and persistence were similar between ACE inhibitors were enalapril and losartan highlighted! Perindopril and captopril switched significantly more often switched to a different drug were excluded, as well as drugs... West DS, Martin BC 2.5.1 ( the GNU Project, www.r-project.org/ ) investigate drug,., Dubois R. patient satisfaction with antihypertensive therapy: the Rotterdam study, J. al. Al ; LIFE study Group characteristics of these drugs constituted 96 % of all RAS inhibitors were and...