Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers: which class of drugs should be preferable for patients with cardiovascular pathology?

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Abstract

The article presents a comparative analysis on the effectiveness of two classes of drugs — angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II type 1 receptor blockers (ARB II) for patients with cardiovascular diseases: arterial hypertension, heart failure, coronary heart disease, ischemic brain disease. The advantage of ACE inhibitors over ARB II in reducing the risk of general and cardiac mortality, myocardial infarction, cerebral strokes, chronic heart failure, chronic kidney disease has been established. The positive effect of ACE inhibitors on the course of a new coronavirus infection is also demonstrated. The mechanisms of action of both classes of drugs are proposed for discussion, which substantiate the advantage of ACE inhibitors over ARB II from the standpoint of pathophysiology in relation to controlling major cardiovascular risks.

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About the authors

Sergey V. Stolov

Saint Petersburg Institute of Medical Experts; North-Western State Medical University named after I.I. Mechnikov

Email: sv100lov@gmail.com
ORCID iD: 0000-0002-3431-1224
SPIN-code: 5492-2429

MD, Dr. Sci. (Med.), Professor

Russian Federation, 11/12 B. Sampsonievsky Ave., Saint-Petersburg, 194044; Saint-Petersburg

Konstantin A. Privalov

Saint Petersburg Institute of Medical Experts

Author for correspondence.
Email: kostus2004@list.ru
ORCID iD: 0000-0002-8917-3332
SPIN-code: 5323-5968
Russian Federation, 11/12 B. Sampsonievsky Ave., Saint-Petersburg, 194044

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2. Fig 1. Independent predictors of in-hospital mortality in the novel coronavirus infection. ACEI — angiotensin-converting enzyme inhibitors; COPD — chronic obstructive pulmonary disease; CI — confidence interval

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3. Fig. 2. The risk of developing pneumonia, depending on the use of drugs. ACEI — angiotensin-converting enzyme inhibitors; ARBs — angiotensin II type 1 receptor blockers; RR — relative risk

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4. Fig. 3. The results of the meta-analysis by M.H. Strauss and A.S. Hall, which included 11 clinical studies, showing that receiving angiotensin II type 1 receptor blockers increases the risk of myocardial infarction. ARBs II — angiotensin II type 1 receptor blockers; RR — relative risk; CI — confidence interval; MI — myocardial infarction

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5. Fig. 4. Influence of drug intake on cardiovascular complications [9]: a — ACE inhibitors vs comparators (39 studies; n = 150,943); b — ARBs II vs comparators (11 studies; n = 55,050). ACE — angiotensin-converting enzyme; ARBs II — angiotensin II type 1 receptor blockers

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6. Fig. 5. Results of the Kyoto Heart Study [25]. AG — arterial hypertension; ARBs — angiotensin receptor blockers

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7. Fig. 6. Cumulative forest plots (bilateral, 95% confidence interval) depending on the presence of myocardial infarction and death from cardiovascular causes [34]. ARBs — angiotensin receptor blockers; OR — odds ratio

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8. Fig. 7. TRANSCEND study results: no effect after taking telmisartan on the primary endpoint (cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure) in patients with intolerance to angiotensin-converting enzyme inhibitors. UR — unreliable

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9. Fig. 8. PRoFESS study results: telmisartan does not contribute to the risk of recurrent stroke. UR — unreliable

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10. Fig. 9. The effect of drugs on overall mortality [42]. ACEI — angiotensin-converting enzyme inhibitors; ARBs — angiotensin receptor blockers; RR — relative risk; CI — confidence interval; UR — unreliable

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11. Fig. 10. Survival after acute myocardial infarction depending on the use of an angiotensin-converting enzyme inhibitor [56]

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Copyright (c) 2021 Stolov S.V., Privalov K.A.

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