2011 Oct; cited 2016 Apr 25]. Angiotensin receptor blockers (ARB), like losartan (Cozaar), are less likely to cause this dry cough. 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. Switching. 2011;105(2):259-365. Am Heart J. 10. 2008;26(4):819-824. 2000;342(10):748]. Variations in compliance, persistence, and switching behavior were detected between specific ACE inhibitors, but not between specific ARBs. 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. 43. References: 8. ; Pregnant women and those planning a pregnancy — due to risks to the fetus. The Md did not say anything about tapering off the beta blocker. 5. 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. Value Health. Importance of medication adherence in cardiovascular disease and the value of once-daily treatment regimens. Adv Ther. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Compliance, persistence, and switching behavior varied between specific ACE inhibitors but not between specific ARBs. The use of different grace periods, such as 60 days or 120 days, did not change the relative order of persistence. Prescribe* and document ACE inhibitor or ARB therapy for patients ≥18 years with HF who have a current or prior LVEF < 40%. 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. In: Strom BL, ed. E-mail: s.vegter@rug.nl. Our study has several limitations. Compliance among users of ramipril (90.4%, P = .05) and fosinopril (91.6%, P = .017) was higher compared with compliance among users of enalapril (87.9%). 2006;23(9):733-741. 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. Switching. Patients and methods: CORD IA involving switching from an angiotensin-converting enzyme inhibitor (ACEI) to the angiotensin II receptor blocker (ARB) losartan. Between the different ACE inhibitors, persistence differed significantly (overall P <.001). Enlund H. Measuring patient compliance in antihypertensive therapy—some methodological aspects. In: Strom BL, ed. 23. Risks for insurance companies are regulated by a national equalization pool. The compliance of ACE inhibitor and ARB users was 88.3% (P = .996) for both classes. Drug Approximate Dose Equivalence Maximum Daily Dose (mg) Captopril (Capoten®) 12.5 mg tid: 150: Enalapril maleate (Vasotec®) 5 mg daily: 40: Enalapril sodium. ACE inhibitors versus ARBs: comparison of practice guidelines and treatment selection considerations. Titrate to maximally tolerated target doses; monitor blood pressure, renal function, and potassium 1 – 2 weeks after initiation and after titrations. 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. 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). 2009;25(9):2303-2310. Ambrosioni E, Leonetti G, Pessina AC, Rappelli A, Trimarco B, Zanchetti A. 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. Ace-inhibitor conversions for all of the common ace-inhibitors based on the estimated potency. In people with stage 3 chronic kidney disease (GFR > 30 ml/min) the combination of an ACE inhibitor with an ARB reduced urine protein levels but did not reduce cardiovascular outcomes and did increase adverse renal outcomes including the need for acute dialysis compared to the ACE inhibitor alone 4. Law MR, Wald NJ, Morris JK, Jordan RE. Good and poor adherence: optimal cut-point for adherence measures using administrative claims data. Differences in compliance were analyzed compared with the reference drug, adjusting for age, sex, year of initiating therapy, and comorbidities. Lancet. For the same reason, frequency of medication administration (eg, once daily, twice daily) could not be analyzed because of indication bias. Available at To investigate compliance, persistence, and switching patterns for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). 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. Pharmacoepidemiol Drug Saf. 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 … 2010;69(2):200-203. Scientific Committee of the Italian Pharmacoepidemiological Survey on Antihypertensive Therapy. 4. Link between ACE inhibitor use and kidney injury highlighted. ACE INHIBITORS AND ARBS CLINICAL GUIDELINE NOVEMBER 2020 CONVERSION TABLES TABLE 2. 2008;11(1):44-47. There was variation in drug-utilization patterns between the specific ACE inhibitors. ACE Inhibitors [CPhA monograph] Available from . 24 After discontinuing the offending agent, 26 patients were switched to an ARB, 14 to a calcium channel blocker, and 14 to other various antihypertensive medications. Vegter S, de Jong-van den Berg LT. 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. Variations in compliance, persistence, and switching behavior were detected between specific ACE inhibitors, but not between specific ARBs. Furthermore, ARBs are associated with placebo-like tolerability,7,8 which may improve therapy compliance and persistence. 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. angiotensin Receptor Blockers (ARB) specifically block the action of angiotensin II at the AT-1 receptor. Journal of Molecular Medicine 84 (2006): 814-820. Together, these findings suggest that patients and physicians prefer to switch drugs rather than increase the pill burden of captopril. Incidence was defined as the first drug used after being present in the database for at least 1 year.23,24 Because up-titration is common and necessary to achieve optimal blood pressure control,31 the dosage was measured 6 months after drug initiation. 2006;41:274-284. 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. Each prescription record contains basic patient characteristics and information on drug, dosage, prescriber (general practitioner or specialist hospital doctors), and dispensing date. Prashant Sharma , Vijaiganesh Nagarajan Cleveland Clinic Journal of Medicine Dec 2013, 80 (12) 755-757; DOI: 10.3949/ccjm.80a.13041 The drug that was most commonly prescribed within its class was used as the reference drug (enalapril for the ACE inhibitors and losartan for the ARBs). Users of ACE inhibitors more often switched therapy (24.2% vs 13.1%, P <.001), primarily to an ARB. 1, https://www.bmj.com/content/368/bmj.m406/rr-19 Four-year persistence patterns among patients initiating therapy with the angiotensin II receptor antagonist losartan versus other antihypertensive drug classes. Objectives: To investigate compliance, persistence, and switching patterns for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). 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