July 26 (UPI) -- Between two drugs that are recommended as treatments for patients with high blood pressure, the more popular one causes more side effects.
A multinational study published Monday in the journal Hypertension compared angiotensin-converting enzyme, or ACE, inhibitors and angiotensin receptor blockers, or ARB, two commonly prescribed antihypertensive drugs, finding that ACE inhibitors have a higher risk for side effects than ARBs.
ACE inhibitors have been available longer and are cheaper, which is why doctors have prescribed them more than ARBs, according to senior author Dr. George Hripcsak.
Both drugs work, and are reasonably safe, he said, but knowing the risk of side effects may help doctors make better decisions for individual patients.
"The study focused on first-time users of these drugs," Dr. Hripcsak wrote. "If you're already taking an ACE inhibitor and you're not having any side effects, there is nothing that we found that would indicate a need for a change."
In the United States and Europe, hypertension guidelines list 30 medications from five different drug classes as choices for medications to control a patient's high blood pressure.
The researchers say there are few studies to help physicians determine which ones are better, and it is unlikely for "head-to-head clinical trials" to be conducted to determine risk because "we are reasonably sure that both are effective."
"In our research, we are trying to fill in this information gap with real-world observational data," he said.
ACE inhibitors are known to carry an increased risk of cough and severe swelling in the face and airways, the researchers said.
Researchers analyzed insurance claims and electronic health records from approximately three million patients in Europe, Korea, and the United States who were treated with ACE inhibitors and ARBs.
Using mathematical techniques to accounts for any human error, they were able to reduce bias and balance the two treatment groups to measure side effects.
They tracked cardiovascular outcomes like heart attacks, heart failure, stroke and sudden cardiac death as well as 51 adverse events in patients after they started treatment.
Of the three million patients, approximately 2.3 million were prescribed the ACE inhibitor and those patients had a "significantly" higher risk of cough and severe swelling, Dr. Hripcsak said.
"Our study largely confirmed that both antihypertensive drug classes are similarly effective, though ARBs may be a little safer than ACE inhibitors," Hripcsak said.
"This provides that extra bit of evidence that may make physicians feel more comfortable about prescribing ARBs versus ACE inhibitors when initiating monotherapy for patients with hypertension," he said.