SeniorJournal.com

INDEX

FRONT PAGE

PAGE TWO
More Headlines

 • General Features

 • Find Help

 • SENIOR ALERTS

 • Baby Boomers

 • Odds & Ends

Health-Fitness

 • Fitness

 • Health/Medicine

 • Medical Research

 • Nutrition/Vitamin

Government

 • Politics

 • Medicare

 • Medicare Drug Program

 • Medicare Q&A - Dear Marci

 • Medicaid

 • Social Security

 • Social Security, Medicare Q&A

 • Social Security Reform

Enjoying Life

 • Books

 • Entertainment

 • Features

 • Grandparents

 • Senior Statistics

 • Senior Stars

 • Sex & Seniors

 • Sports

 • Travel

 • Senior Volunteers

On The Web

 • Links - Senior

 • Senior Friendly Business Links

 • Sites We Like

Elderly Issues

 • Elder Care

 • Assistance for Elderly

 • Housing

Money 

Thinking

 • Opinions

E-mail this page to a friend!

Senior Citizen Health & Medicine

High Blood Pressure Control is Equal with Common Medications

ACEIs more likely than ARBs to cause harmless, persistent cough

Nov. 2, 2007 - Two common classes of blood pressure medications – angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) – are equally effective at controlling high blood pressure, which strikes half of all senior citizens, according to a report released today by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

The report, which analyzed published results from 61 studies, also found that ACEIs are slightly more likely than ARBs to cause a harmless but persistent dry cough.  A summary of the report will be posted on-line in the Annals of Internal Medicine.

Authors of the report also said that more research is needed to learn how ACEIs and ARBs may differ when it comes to longer term benefits and harms.  In particular, more information is needed about how the medications may differ in decreasing the risks of heart attack, stroke, or death.

 “An enormous number of Americans have high blood pressure, and we need to provide them with the best information possible about their medications’ potential benefits and harms,” said AHRQ Director Carolyn M. Clancy, M.D.  “This report summarizes the current scientific evidence on these medications and helps set the agenda for needed research.”

Blood pressure is the force of blood pushing against artery walls.  The cause of high blood pressure (140/90 mmHg or higher) is often unknown.  Systolic pressure measures pressure during a heartbeat.  Diastolic pressure measures pressure between beats.  Because it typically has no symptoms, high blood pressure – also known as hypertension – is often called “the silent killer.”

More than 65 million American adults – about one-third of the adult population – have high blood pressure but the risk increases with age. One out of two of those over age 60 have hypertension. 

If left untreated, high blood pressure can cause catastrophic health problems: the heart may enlarge, which can lead to heart failure; small bulges – aneurysms – may form in blood vessels, including the aorta (the main artery to the heart) and others in the brain, legs, and intestines; blood vessels in the kidney may narrow, causing kidney failure; blood vessels in the eyes may burst or bleed, possibly leading to blindness; and arteries throughout the body may "harden" faster, potentially leading to heart attack or stroke.

The AHRQ-funded study, completed by the Agency’s Duke University Evidence-based Practice Center in Durham, N.C., compared both the benefits and harms of ACEIs and ARBs.  Both classes of drugs control blood pressure effectively by targeting a key hormone that helps regulate blood pressure.  The AHRQ-funded study did not include other blood pressure treatments such as diuretics or beta blockers.

 The ACEIs included in the AHRQ analysis were benazepril (sold as Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik).  The ARBs included were candesartan cilexetil (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan medoxomil (Benicar), telmisartan (Micardis), and valsartan (Diovan).

Among the report’s conclusions:

  ● ACEIs and ARBs are equally effective at controlling blood pressure.  This conclusion is based on studies that included 16,597 patients who were followed for periods from 12 weeks to 5 years.

  ● In studies of patients in everyday clinical settings, a dry cough was reported by about 1.7 percent of patients who took ACEIs and about 0.6 percent who took ARBs.  Patients who took ACEIs in clinical trials were slightly more likely than patients who took ARBs to withdraw from the studies.

  ● It is unknown whether ACEIs and ARBs differ when it comes to long-term benefits and risks. Among available studies, there are not enough cases of death or stroke to make conclusions. More research is needed.

  ● There are no consistently apparent differences between ACEIs and ARBs when it comes to impacting blood fats known as lipids, managing or slowing the progression of diabetes, controlling renal disease, or impacting heart function.

  ● More research is needed to compare the drugs’ benefits and harms for hypertension patients who have additional health problems, such as diabetes, congestive heart failure, chronic kidney disease, and dyslipidemia (an imbalance in lipid/cholesterol metabolism). Future studies should include more patients who are older and from ethnic and racial minorities.

The new report, Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension, is the newest analysis from AHRQ's Effective Health Care program.

That program is an ongoing federal effort to compare alternative treatments for significant health conditions and make the findings public.  The program helps patients, doctors, nurses, and others choose the most effective treatments.

The full report is available at AHRQ’s Effective Health Care Web site, click here.  Also available at the site are links to guides that summarize the report in plain language. A guide for consumers offers basic information on treating high blood pressure, the drugs’ effectiveness and possible side effects, and average wholesale pricing. 

A guide for clinicians contains similar information and a “confidence scale” that measures the strength of current scientific evidence, plus identifies clinical areas where knowledge is lacking.  Both guides warn that the medications can cause birth defects or fetal death when taken during pregnancy.

What are some common medicines to treat high blood pressure?

There are 8 types of medicine used to treat high blood pressure. Your doctor will decide which type of medicine is right for you.

Diuretics (water pills) help your body get rid of extra sodium (salt) and water so your blood vessels don't have to hold so much fluid. Some examples of diuretics include chlorthalidone (brand name: Thalitone), furosemide (brand name: Lasix), hydrochlorothiazide (brand name: Esidrix) and indapamide (brand name: Lozol). Your doctor may also prescribe a combination of diuretics, such as hydrochlorothiazide combined with triamterene (brand names: Dyazide, Maxzide).

Beta-blockers make the heart beat slower so that blood passes through your blood vessels with less force. Some examples of beta-blockers include acebutolol (brand name: Sectral), atenolol (brand name: Tenormin), carvedilol (brand name: Coreg), metoprolol (brand names: Lopressor, Toprol XL), nadolol (brand name: Corgard), propranolol (brand name: Inderal) and timolol (brand name: Blocadren).

Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) keep your body from making angiotensin II, a hormone that causes blood vessels to narrow. Some examples of ACE inhibitors include benazepril (brand name: Lotensin), enalapril (brand name: Vasotec), lisinopril (brand names: Prinivil, Zestril), quinapril (brand name: Accupril), ramipril (brand name: Altace) and trandolapril (brand name: Mavik).

Angiotensin II receptor blockers (also called ARBs) protect your blood vessels from the effects of angiotensin II, a hormone that causes blood vessels to narrow. Some examples of ARBs include candesartan (brand name: Atacand), irbesartan (brand name: Avapro), losartan (brand name: Cozaar), olmesartan (brand name: Benicar), telmisartan (brand name: Micardis) and valsartan (brand name: Diovan).

Calcium channel blockers (also called CCBs) help keep your blood vessels from constricting (becoming narrow) by blocking calcium from entering your cells. Some examples of CCBs include amlodipine (brand name: Norvasc), diltiazem (brand names: Cardizem, Cartia, Dilacor, Tiazac), felodipine (brand name: Plendil), nicardipine (brand name: Cardene), nifedipine (brand names: Adalat, Procardia) and verapamil (some brand names: Calan, Covera, Isoptin, Verelan).

Alpha-blockers help relax your blood vessels by reducing nerve impulses. This allows your blood to pass through more easily. Some examples of alpha-blockers include doxazosin (brand name: Cardura), prazosin (brand name: Minipress) and terazosin (brand name: Hytrin).

Centrally acting drugs affect your brain and central nervous system to reduce the nerve impulses that can cause your blood vessels to narrow. Some examples of centrally acting drugs include clonidine (brand name: Catapres) and methyldopa.

Direct vasodilators relax the muscles in the blood vessel walls. This causes the blood vessels to widen. Some examples of vasodilators include hydralazine (brand name: Apresoline) and minoxidil (brand name: Loniten).

 >> Seniors and Blood Pressure Medicines (American Academy of Family Physicians)

  >> About High Blood Pressure at MedlinePLUS

Search for more about this topic on SeniorJournal.com
		Web	SeniorJournal.com

Click to More Senior News on the Front Page

Copyright: SeniorJournal.com