Do angiotensin receptor blockers have untoward cardiac effects?
An editorial in today’s BMJ discusses evidence from recent clinical trials suggesting that angiotensin receptor blockers (ARB) may be less effective in reducing clinical outcomes than ACE inhibitors, despite producing similar reductions in blood pressure. Using data from trials of valsartan, candesartan, irbesartan, and losartan, the authors show that despite lowering blood pressure in hypertension, in contrast to ACE inhibitors ARB seem not to be effective in reducing myocardial infarction. In patients with diabetic renal disease, they appear to offer similar degrees of nephroprotection but have no effect on cardiovascular events or mortality. The authors suggest that until the results of ongoing large comparative trials are known, these drugs should not be considered as ACE inhibitors without the cough.