Image of George Hripcsak, M.D.

Two drug classes excel at reducing adverse heart events from high blood pressure, but the most commonly prescribed choice is more likely to cause side effects, a new study finds.

The drugs in question are angiotensin-converting enzyme, or ACE, inhibitors and angiotensin receptor blockers, or ARBs, both used for treating hypertension. 

“Physicians in the United States and Europe overwhelmingly prescribe ACE inhibitors, simply because the drugs have been around longer and tend to be less expensive than ARBs,” researcher George Hripcsak, M.D., of Columbia University, said. “But our study shows that ARBs are associated with fewer side effects than ACE inhibitors.”

Investigators focused on data from 3 million first-time users being treated for high blood pressure. When they looked at 51 possible side effects and safety concerns, the patients taking ARBs were significantly less likely to develop tissue swelling, cough, pancreas inflammation and bleeding in the digestive tract, Hripcsak and colleagues reported. 

But both drug classes were equally as good at preventing cardiovascular events linked to hypertension, including heart attack, stroke and heart failure.

The takeaway? “If you’re just starting drug therapy for hypertension, you might consider trying an ARB first. If you’re already taking an ACE inhibitor and you’re not having any side effects, there is nothing that we found that would indicate a need for a change,” the researchers concluded.

Once high blood pressure is diagnosed, the decision on which drug to choose can be daunting for clinicians, the authors noted. Hypertension guidelines list 30 medications from five different drug classes as possible choices, “yet there are very few head-to-head studies to help physicians determine which ones are better,” Hripcsak said. 

“In our research, we are trying to fill in this information gap with real-world observational data,” he wrote.

Full findings were published in the American Heart Association journal Hypertension. A summary report on the findings can be found here.