World Health Organ Tech Rep Ser. 30. The most frequent prescribed ACE inhibitor was enalapril (37.2%) and the most frequent prescribed ARB was losartan (34.5%); these drugs were used as reference drugs. Automated pharmacy record linkage in the Netherlands. When RAAS blockade is needed but ACE inhibitors are not well tolerated due to a persistent dry cough, ARBs can be considered as an alternative (ARBs should be avoided as an alternative to ACE inhibitors in patients who develop severe renal insufficiency or hyperkalaemia as … Titrate to maximally tolerated target doses; monitor blood pressure, renal function, and potassium 1 – 2 weeks after initiation and after titrations. Respir Med. In contrast, there were no significant differences in persistence among ARB users (overall P = .073). There is limited evidence to suggest that a significant number of patients who develop angioedema while taking ARBs have previously experienced angioedema during ACE inhibitor therapy. Different angiotensin-converting enzyme inhibitors have similar clinical efficacy after myocardial infarction. The dosage was expressed in defined daily doses (DDDs); 1 DDD is the mean dose per day for a drug used for its main indication in adults.32. If used for heart failure with reduced ejection fraction or kidney disease with albuminuria, re-start at a lower dose once serum K < 5.5 mmol/L and then continue to monitor: if the patient was on a combination of ACE or ARB … 2003;326(7404):1427. Hasford J, Mimran A, Simons WR. All rights reserved. Researchers have previously received independent research grants from sanofi-aventis (manufacturer of ramipril, irbesartan, and losartan) and Daiichi-Sankyo (manufacturer of captopril and olmesartan). 31. Higher patient age and comedication for dyslipidemia increased the chance of being compliant (9.4% and 25.6% over 10 years, respectively, Users of ACE inhibitors switched drugs more than ARB users. A recent meta-analysis of 32 placebo-controlled trials suggested that all ACE inhibitors have similar efficacy for reducing mortality in congestive heart failure.13 Results from observational studies, on the other hand, present conflicting evidence regarding the existence of a class effect.14,15 Similarly, recent reviews were unable to draw conclusions on the comparative efficacy of specific ARBs.12,16 Real-life drug-utilization patterns can supplement evidence from clinical trials.11,17 First, drug compliance and persistence are recognized markers of drug efficacy and tolerability.18 Second, therapy switches are signs of unsatisfactory treatment response and unacceptable adverse effects.19,20. While switching was more common in ACE inhibitor users, compliance and persistence were similar between ACE inhibitors and ARBs. Therefore switching from ACE inhibitors to ARB might be beneficial in patients at risk or with COVID-19 in prevention of such sequelae when they are already on therapy affecting the Renin-Angiotensin System. The 2 exceptions were captopril, which was prescribed below the DDD of 50 mg in 65% of patients, and ramipril, which was prescribed above the DDD of 2.5 mg in 70% of patients. Comorbidities were recorded by proxy of comedication, prescribed before or at maximum half a year after initiating RAS inhibiting therapy. 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). Therefore switching from ACE inhibitors to ARB might be beneficial in patients at risk or with COVID-19 in prevention of such sequelae when they are already on therapy affecting the Renin-Angiotensin System. 2004;13(3):173-179. © 2021 MJH Life Sciences™ and Clinical Care Targeted Communications, LLC. Choice of first antihypertensive—comparison between the Irish and Dutch setting. The history of the Drug Utilization Research Group in Europe. Temporal confounding, for example through publication of new trial evidence, might have influenced drug-utilization patterns. ACE inhibitors should not be combined with ARBs because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment. Address correspondence to: Stefan Vegter, PharmD, Unit of Pharmaco-Epidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. 9. Variations in compliance, persistence, and switching behavior were detected between specific ACE inhibitors, but not between specific ARBs. Scientific Committee of the Italian Pharmacoepidemiological Survey on Antihypertensive Therapy. Monitoring requirements when switching ACE-inhibitors • Serum Potassium levels • Renal function (Creatinine clearance) • Blood pressure • Care should be taken in patients on diuretic therapy (monitor for hypotension). Vink NM, Klungel OH, Stolk RP, Denig P. Comparison of various measures for assessing medication refill adherence using prescription data. Incident users of RAS inhibitors (ATC C09) older than 18 years were included. Vegter S, de Jong-van den Berg LT. 23. OR. 13. Menopause. 12. 16. Differences in compliance were tested using logistic regression. Authorship Information: Concept and design (SV, NHN, STV, LJ, MJP, CB); acquisition of data (SV, NHN, STV); analysis and interpretation of data (SV, NHN, STV, CB); drafting of the manuscript (SV, MJP, CB); critical revision of the manuscript for important intellectual content (SV, STV, LJ, MJP, CB); statistical analysis (SV, NHN, STV); administrative, technical, or logistic support (STV); and supervision (LJ, MJP, CB). 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