Is there a difference between an angiotensin-converting enzyme inhibitor and an angiotensin-specific receptor blocker for the treatment of hypertension?

Abstract

The renin-angiotensin system (RAS) and angiotensin II, in particular, play a central role and have been implicated in the spectrum of cardiovascular disease (CVD), beginning with hypertension, diabetes mellitus, atherosclerosis, myocardial infarction (MI), strokes and heart failure. Modulation of the RAS by the two most widely used inhibitors of the system, i.e. angiotensin-converting enzyme (ACE) inhibitors and angiotensin-specific receptor blockers (ARBs) plays a crucial role in the primary and secondary prevention of cardiovascular events. These drugs both target angiotensin II, but in different ways. The ACE inhibitor reduces the formation of angiotensin II, and the ARB blocks the angiotensin II receptor. This difference in action against angiotensin II has led to the longstanding issue of whether or not there is a clinically significant difference between the two when treating hypertension. Are they equally effective? The problem from a clinical viewpoint is that the majority of patients with hypertension also have other cardiovascular risk factors which increase the cardiovascular risk of hypertension, and which may change the choice of the drugs used, i.e. the concept of compelling indications.