Ruggenenti P, Perna A, Loriga G, et al; REIN-2 Study Group. In: Strom BL, ed. 2007;10(5):431-441. Berlin, Germany: Springer-Verlag; 2000:206-211. 7. For example, in people with diabetes, increases in serum creatinine following initiation of an ACE inhibitor or ARB are typically offset by a slower subsequent rate of decline of renal function and these medicines have been shown to reduce progression of diabetic nephropathy. 20. 27. 2008;178(10):1303-1311. 13. Based on this he continued to argue that the question is not “should” patients taking medium doses of ACEI or ARB be switched, but rather “how.” He explained that “forcing” patients to up titrate to highest dose of ACEI first (enalapril 10mg twice daily) before switching to the ARNI, may have risks, and is not preferable. Between the different ACE inhibitors, persistence differed significantly (overall P <.001). Intern Med J. Document contraindication(s) to ACE/ARB. 2009;958:1-242. 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. 1991;325(5):293-302. Fixed-dose combinations with diuretics were also included. Medication compliance and persistence: terminology and definitions. 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. Predictors and Consequences of Nonadherence to Antihypertensive Medication [dissertation]. Dusing R. Adverse events, compliance, and changes in therapy. J Clin Hosp Pharm. J Hypertens. This difference in switching rates was not dependent on the year of starting therapy or any other possible confounders. Mancia G, Laurent S, Agabiti-Rosei E, et al. 24 After discontinuing the offending agent, 26 patients were switched to an ARB, 14 to a calcium channel blocker, and 14 to other various antihypertensive medications. A trial of 54 patients, all of whom experienced ACE inhibitor–induced angioedema, was performed to determine the safety of using other antihypertensive medications in this population. Dosage range for ACE-Inhibitors3 Captopril 12.5 – 150mg daily (in 2 or 3 divided doses) Enalapril 2.5 – 40mg daily Users of ACE inhibitors more often switched therapy (24.2% vs 13.1%, P <.001), primarily to an ARB. Several cases described a washout period of less than 36 hours when switching from an ACE inhibitor to Entresto. 2002;16(8):569-575. 2007;15(5):257-263. ; Pregnant women and those planning a pregnancy — due to risks to the fetus. My blood pressure has been very well controlled (averaging 115/65) for some weeks now but 1) I have that very difficult, dry tickle cough that sometimes comes with ACE inhibitors and 2) my potassium levels have been on the rise. In conclusion, although residual confounding and indication bias cannot be ruled out, this study showed that compliance, persistence, and switching behavior varied among users of different ACE inhibitors, but not among users of different ARBs. Angioedema Avoid use in patients with a history of angioedema due to ACEI or ARB, hereditary or idiopathic angioedema Do not use combination of ACEI or ARB with Entresto Ensure 36 hours washout period when switching from an ACEI Hypotension Avoid use if systolic BP is less than 100mmHg All statistical analyses were performed using R, version 2.5.1 (the GNU Project, www.r-project.org/). The compliance of ACE inhibitor and ARB users was 88.3% (P = .996) for both classes. 23 Most patients will not have increases in serum creatinine that necessitate withdrawal of treatment. 24. Nat Rev Cardiol (2020). 28. 2011;105(2):259-365. 29. Tu K, Manuel D, Lam K, Kavanagh D, Mitiku TF, Guo H. Diabetics can be identified in an electronic medical record using laboratory tests and prescriptions. Users of ramipril and fosinopril showed the highest persistence: 85.8% and 83.4%, respectively (P <.001 and P = .047 vs enalapril, respectively). Schirm E, Monster TB, de Vries R, van den Berg PB, de Jong-vanden Berg LT, Tobi H. How to estimate the population that is covered by community pharmacies? Compliance, persistence, and switching behavior varied between specific ACE inhibitors but not between specific ARBs. 2010;117(3):163-173. Furthermore, the findings showed no clinical reason to switch from an ARB to an ACE inhibitor to minimize COVID-19 risk. 2008;68(9): 1207-1225. However, for patients who have to continue to take ACE inhibitors, picotamide may be the drug of choice. 37. Losartan) appears to be equal to that of atenolol or ACE inhibitors; ARBs and thiazide diuretics may be combined, resulting in additive hypotensive effects. Sharma PP. Tobi H, van den Berg PB, de Jong-van den Berg LT. Comparing methods to identify general internal medicine clinic patients with chronic heart failure. Indeed, our results showed that switching was more frequent among users of ACE inhibitors compared with users of ARBs, in agreement with previous studies.9 Reasons for the difference in switching patterns between ACE inhibitors and ARBs at the class. Angiotensin receptor blockers (ARB), like losartan (Cozaar), are less likely to cause this dry cough. Based on this he continued to argue that the question is not “should” patients taking medium doses of ACEI or ARB be switched, but rather “how.” He explained that “forcing” patients to up titrate to highest dose of ACEI first (enalapril 10mg twice daily) before switching to the ARNI, may have risks, and is not preferable. Prescription data for 53,000 incident users of ACE inhibitors and ARBs were collected. Whereas drug compliance refers to treatment intensity, drug persistence focuses on treatment duration. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. 2004;164(8):910-913. Patients who discontinued therapy or switched to a different drug were excluded, as this behavior was assessed in separate analyses. Do not administer within 36 hours of switching from or to an ACE inhibitor. Rutgers, The State University of New Jersey; 2007. Captopril users often switched to a different ACE inhibitor. Our study has several limitations. 4,016 patients with blood pressure (BP) < 160/100 mm Hg who had been treated with an ACEI for > 3 months were enrolled. 2000;342(3):145-153. 31. Did you know that your browser is out of date? 2, Kuba, Keiji et al. 4. Frishman WH. CMAJ. Cramer JA, Roy A, Burrell A, et al. Pharmacoepidemiology. Dosage range for ACE-Inhibitors3 Captopril 12.5 – 150mg daily (in 2 or 3 divided doses) Enalapril 2.5 – 40mg daily Gray J, Majeed A, Kerry S, Rowlands G. Identifying patients with ischaemic heart disease in general practice: cross sectional study of paper and computerised medical records. angiotensin Receptor Blockers (ARB) specifically block the action of angiotensin II at the AT-1 receptor. Incidence, drug dosage, 1-year compliance, long-term persistence, and switching patterns were analyzed. In: Brause RW, Hanisch E, eds. Gogovor A, Dragomir A, Savoie M, Perreault S. Comparison of persistence rates with angiotensin-converting enzyme inhibitors used in secondary and primary prevention of cardiovascular disease. N Engl J Med. Apart from factors leading to therapy switches, compliance and persistence were similar between ACE inhibitors and ARBs. “Based on our results, if there is a risk difference, it’s marginal and would be very challenging to further refine outside such a large-scale international study,” Suchard said. Patients and methods: CORD IA involving switching from an angiotensin-converting enzyme inhibitor (ACEI) to the angiotensin II receptor blocker (ARB) losartan. Comparison of Angiotensin Converting Enzyme (ACE) Inhibitors. Menopause. N Engl J Med. Vink NM, Klungel OH, Stolk RP, Denig P. Comparison of various measures for assessing medication refill adherence using prescription data. In the present study we analyzed drug-utilization patterns of RAS inhibitors. Compliance. Cardiol Rev. How to titrate ACE inhibitors and angiotensin receptor blockers in renal patients: according to blood pressure or proteinuria? Although these medication classes work in a similar fashion, ARBs do not inhibit kinase II which is thought to be responsible for the cough. Users of ACE inhibitors switched drugs more than ARB users. A novel finding of our study is that, apart from factors leading to therapy switches, compliance and persistence were similar between ACE inhibitors and ARBs. 2005;19(10):793-799. Variations in compliance, persistence, and switching behavior were detected between specific ACE inhibitors, but not between specific ARBs. CMAJ. www.e-therapeutics.ca. 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. Smith DH. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have similar clinical effects but differ in their pharmacology: ACE inhibitors block the conversion of angiotensin I to angiotensin II and prevent the breakdown of bradykinin whilst ARBs selectively block the AT1 receptor. 2003;326(7404):1427. No competing interests, Cardiovascular and Transplant Surgery Centre, Copyright © 2021 BMJ Publishing Group Ltd 京ICP备15042040号-3, https://www.bmj.com/content/368/bmj.m406/rr-19, https://doi.org/10.1038/s41569-020-0360-5, Women’s, children’s & adolescents’ health, Switching from ACE inhibitors to ARB in preventing severe course of COVID-19. 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. On the contrary switching to other antihypertensive drugs at the moment of upregulation of AT1 receptors and ACE2 or even starting the treatment with ARB in ARB-naïve patients is controversial. 2008;178(10):1316-1319. So, doctors may choose a medication from either of these classes for various reasons. J Hypertens. Caetano PA, Lam JM, Morgan SG. Comorbidities were more common in users of ACE inhibitors compared with ARB users, including DM (19.8% vs 14.5%), dyslipidemia (38.3% vs 30.6%), IHD (40.7% vs 30.3%), HF (21.6% vs 14.3%), and COPD (3.8% vs 3.0%); users of ACE inhibitors also were more likely to comedicate with diuretics (57.6% vs 55.5%) (all P <.001). Together, these findings suggest that patients and physicians prefer to switch drugs rather than increase the pill burden of captopril. 26. WHO Expert Committee. Lancet. Vitry A, Lai YH. Prescription data between 1999 and 2010 were retrieved from the IADB.nl database, which holds a representative sample of the Dutch population of more than 500,000 individuals. Clin Ther. Risks for insurance companies are regulated by a national equalization pool. The objective of our study was to investigate drug compliance, persistence, and switching patterns of RAS-inhibiting agents in newly treated patients. J Clin Epidemiol. 1995;273(18): 1450-1456. 30. A total of 51,181 patients initiated therapy on the predefined drugs. The most frequently prescribed RAS inhibitors were enalapril and losartan. These effects have been described previously (eg, for nonantihypertensive medications after discovery of serious side effects49). The type of medical prescriber was similar for users of ACE inhibitors and ARBs (percentage of general practitioners was 66.5% for users of ACE inhibitors vs 66.9% for users of ARBs, P = .465). Gumbs PD, Verschuren WM, Mantel-Teeuwisse AK, et al. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Cicardi M, Zingale LC, Bergamaschini L, Agostoni A. Angioedema associated with angiotensin-converting enzyme inhibitor use: outcome after switching to a different treatment. Drug persistence is defined as “the duration of time from initiation to discontinuation of therapy.”33 Persistence was measured using the refill-sequence method. 43. 48. Incidence was defined as the first drug used after being present in the database for at least 1 year.23,24 Because up-titration is common and necessary to achieve optimal blood pressure control,31 the dosage was measured 6 months after drug initiation. On the drug level, several differences between the ACE inhibitors were detected. These results at first glance seem to disagree with results of previous studies, including one study in 15,000 hypertensive patients that reported superior persistence with ARBs.9 However, in our study, patients were censored at the time of switching. In monotherapy, it has shown greater efficacy in lowering BP than ACE-inhibitors and calcium-channel blockers.12,13 However, it was associated with an unacceptable risk of angioedema due to excessive inhibition of bradykinin degradation (presumably via neprilysin, ACE, and aminopeptidase P).3–5 In contrast to omapatrilat, in LCZ696, the ACE inhibition has been replaced with an angiotensin … There was variation in compliance between the specific molecules (), both without and with adjustment for age, sex, year of initiating therapy, and comorbidities. Clin Ther. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. 2. Question: switching from beta blocker to ace inhibitor cmvm - Tue May 05, 2009 1:01 pm: Share | My 42 yo husband has been on atenolol 100mg daily for over a year. Prashant Sharma , Vijaiganesh Nagarajan Cleveland Clinic Journal of Medicine Dec 2013, 80 (12) 755-757; DOI: 10.3949/ccjm.80a.13041 There was variation in drug-utilization patterns between the specific ACE inhibitors. 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. J Hypertens. The use of different grace periods, such as 60 days or 120 days, did not change the relative order of persistence. 2004;10(4):499-509. 3. No such censoring was used in other studies, and as a consequence, these studies failed to detect the similarity in compliance and persistence between drug classes. 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). Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients into lerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. ACE Inhibitor Dose Equivalency Table. An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors. ENTRESTO is contraindicated in patients with a history of angioedema related to previous angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy. Users of perindopril and captopril switched significantly less often to an ARB compared with users of enalapril. 2009;18(2):159-165. Value Health. After 3 years of therapy, 24.2% of ACE inhibitor users had switched therapy, compared with 13.1% of ARB users (P <.001). Although the differences between ACE inhibitors found in our study are supported by the literature and are indicative of differences in drug tolerability profiles, there is no proven causality. On a group level, ARBs are sometimes proposed to be superior to ACE inhibitors.9 However, comparative studies often fail to demonstrate clinically relevant differences between ACE inhibitors and ARBs, and guidelines commonly suggest they are equivalent for nearly all indications.10, Complicating these matters is the debate surrounding the comparative effectiveness of specific ACE inhibitors and ARBs.11,12 For the specific drugs there is no conclusive evidence on differences in drug efficacy and tolerability. Miller AE, Cziracky M, Spinler SA. BMJ. RAS inhibitors have demonstrated efficacy for intermediate parameters such as blood pressure and proteinuria, but also for cardiovascular mortality and end-stage renal disease.2-6, Angiotensin-converting enzyme inhibitors are widely used as firstchoice RAS inhibitors because of long experience and low costs compared with ARBs. Peterson AM, Nau DP, Cramer JA, Benner J, Gwadry-Sridhar F, Nichol M. A checklist for medication compliance and persistence studies using retrospective databases. At least one of these exceptions must be documented in the patient record lieu of prescription, if they apply: Medical reason(s) for not prescribing ACE/ARB therapy Do not administer within 36 hours of switching from or to an ACE inhibitor. While switching was more common in ACE inhibitor users, compliance and persistence were similar between ACE inhibitors and ARBs. ACE inhibitors versus ARBs: comparison of practice guidelines and treatment selection considerations. His Md has switched him to lisinopril 10mg daily. Choice of first antihypertensive—comparison between the Irish and Dutch setting. ACE to ARB Conversion Table Angiotensin Receptor Blocker (ARB) Dose Conversion Drugs Low Dose Medium Dose High Dose losartan (Cozaar) 125. Drug costs associated with non-adherence to cholesterol management guidelines for primary prevention of cardiovascular disease in an elderly population: the Rotterdam study. 2009;39(11):728-732. Comparison of angiotensin II type 1 receptor antagonists in the treatment of essential hypertension. After excluding 24,805 patients who discontinued or switched treatment, 20,236 ACE inhibitor users and 6140 ARB users were analyzed for 1-year compliance. Differences in persistence and switching patterns were plotted using Kaplan-Meier plots and tested using the log-rank test and Cox proportional hazard analysis. 26 In the Netherlands, healthcare insurance is semiprivatized. Candesartan users were less compliant and switched less often compared with users of other ARBs. Objectives: To investigate compliance, persistence, and switching patterns for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). 49. Users of candesartan switched less often to another RAS inhibitor compared with users of losartan. © 2021 MJH Life Sciences™ and Clinical Care Targeted Communications, LLC. Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. Curr Hypertens Rep. 2003;5(5):426-429. outcomes compared to the ACE inhibitor alone. These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC. New study presents "strong evidence" that continuing ACE inhibitor/ARB therapy in typical patients with chronic renal disease and declining kidney function "does not lead to harm" and ups survival. Furthermore, ARBs are associated with placebo-like tolerability,7,8 which may improve therapy compliance and persistence. Still, the real-life drugutilization patterns of our study should provide valuable data to supplement evidence from clinical trials.11. Lancet. 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). Link between ACE inhibitor use and kidney injury highlighted. 2000;342(10):748]. The time between the first prescription and the point at which an unacceptable prescription gap occurs was measured.36 The length of this unacceptable gap or “grace period” was 90 days.36,37 In case of overlapping prescriptions, the second prescription was shifted forward to account for drug stockpiling.38 Patients were censored when lost to follow-up or when switching therapy, as switching was analyzed separately. Higher patient age and comedication for dyslipidemia increased the chance of being compliant (9.4% and 25.6% over 10 years, respectively, P <.001), while comedication for COPD and later year of initiating therapy decreased the chance of being compliant (-24.3% per year [P = .005] and -1.5% per year [P = .035], respectively). tool for switching between agents in canada ©2018 Canadian Pharmacists Association The information provided is intended to help prescribers select an alternative agent from the angiotensin II receptor antagonist (ARB) class. References: 2002;359(9311):995-1003. level deserve careful attention. 21. 19. Brenner BM, Cooper ME, de Zeeuw D, et al; RENAAL Study Investigators. of ACEI and ARB): If used for hypertension, consider an alternative antihypertensive drug. 2005;365(9463):939-946. Persistence data are shown in Table 2 and and. Am Heart J. ENTRESTO is contraindicated in patients with a history of angioedema related to previous angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy. Enlund H. Measuring patient compliance in antihypertensive therapy—some methodological aspects. A dry, persistent cough is a well-described class effect of the angiotensin-converting enzyme (ACE) inhibitor medications. Higher age (hazard ratio [HR] = 0.91 per 10 years, P <.001), later year of initiating therapy (HR = 0.71 per year, P <.001), comedication for IHD (HR = 0.90, P = .001), and comedication for HF (HR = 0.75, P <.001) increased the chance of being persistent, while comedication for dyslipidemia (HR = 1.24, P <.001), comedication for COPD (HR = 1.26, P = .001), or use of diuretics (HR = 1.15, P <.001) decreased the chance of being persistent. Hansen ML, Gislason GH, Kober L, et al. https://doi.org/10.1038/s41569-020-0360-5, Competing interests: 5,9,10 Since ARBs do not affect ACE, the incidence of cough in patients taking these agents is much lower and has been found to be comparable to that of placebo in large clinical trials. Arch Intern Med. 26 JUL 2013. If a patient begins to cough and I switch from an ACE inhibitor to an angiotensin receptor blocker (ARB), will the positive bradykinin endothelial and/or the nephroprotective effects be lost? Document contraindication(s) to ACE/ARB. For the same reason, frequency of medication administration (eg, once daily, twice daily) could not be analyzed because of indication bias. This is in accordance with evidence that once-daily antihypertensive dosing regimens are associated with superior compliance.44 Users of ramipril and fosinopril showed high rates of compliance and persistence, which might indicate favorable drug tolerability profiles compared with other ACE inhibitors. Leufkens HGM, Urquhart J. These results are in accordance with a previously published study analyzing compliance and persistence in more than 6000 ACE inhibitor users, which also found the highest compliance and persistence for ramipril and the lowest for enalapril.45 In contrast to ACE inhibitors, the specific ARBs had very similar patterns of drug utilization. 8. ACE inhibitor plus ARB ruled out for … If a patient begins to cough and I switch from an ACE inhibitor to an angiotensin receptor blocker (ARB), will the positive bradykinin endothelial and/or the nephroprotective effects be lost? Available at Incidence and Dosage. Value Health. Drug-utilization analysis using a large prescription database. Within the ARB group, users of candesartan were found to be significantly less compliant than users of losartan (86.1% vs 88.8%, P = .027). Angiotensin-Converting Enzyme Inhibitor-Induced Cough ACCP Evidence-Based Clinical Practice Guidelines Peter V. Dicpinigaitis, MD, FCCP Background: A dry, persistent cough is a well-described class effect of the angiotensin-converting enzyme (ACE) inhibitor medications. 36. The one large head-to-head ACE inhibitor versus ARB trial, ELITE-2, did not show superiority or even noninferiority of the ARB, which may have been due to the low dose of ARB used, while the only placebo-controlled trial of an ARB was one in patients intolerant to ACE inhibitors and did not show a statistically significant reduction in mortality. Pharmacoepidemiol Drug Saf. 6. Vegter S, de Jong-van den Berg LT. 41. 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). Compliance among users of ramipril (90.4%, P = .05) and fosinopril (91.6%, P = .017) was higher compared with compliance among users of enalapril (87.9%). 33. N Engl J Med. These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. 1. The 2 drug classes were compared, as well as specific drugs within the drug classes. All rights reserved. Drugs Aging. tool for switching between agents in canada ©2018 Canadian Pharmacists Association The information provided is intended to help prescribers select an alternative agent from the angiotensin II receptor antagonist (ARB) class. Welcome to the equivalent dose and drug conversions / transfers / switching section of the website for physicians and pharmacists. Vegter S, Kölling P, Töben M, Visser ST, de Jong-van den Berg LT. 2009;27(11):2121-2158. Caro JJ, Speckman JL, Salas M, Raggio G, Jackson JD. Based on empiricalstudies to predict hospitalizations for hypertension and congestive HF,35 a threshold of 80% was used to dichotomize between compliant and noncompliant patients. Int J Clin Pract. 2011 Oct; cited 2016 Apr 25]. Although residual confounding and indication bias cannot be ruled out, this study showed that compliance, persistence, and switching behavior varied between specific ACE inhibitors but not between specific ARBs. Results were adjusted for age, sex, starting date, and comorbidities. Of cheap generic ARBs on statin and antihypertensive Utilization survival in patients with reduced left ventricular ejection fractions and heart! Sons Ltd ; 2008:347-360 science and practice in pharmacy Plauschinat CA, F! Losartan on renal and cardiovascular outcomes in patients with type 2 diabetes value of low Dose combination treatment with pressure! Frech F, Harper a, Parodi a, Dubois R. patient satisfaction with antihypertensive therapy described previously (,! Lisinopril to losartan may help reduce the likelihood of developing a dry, cough. Users, compliance and persistence diabetes and nephropathy randomised controlled trial different angiotensin-converting-enzyme inhibitors on mortality among elderly with... Therapy on the year of initiating therapy, and comorbidities persistence patterns among patients initiating with! As well as specific drugs within the drug of choice UK: John Wiley & Sons Ltd ;.. Were detected this behavior was assessed ( ATC C09 ) older than 18 years were included evaluation study [... To angiotensin II type 1 receptor antagonists in the Netherlands, healthcare insurance is semiprivatized general internal clinic!, eds ACE in tolerant subjects with cardiovascular disease ( TRANSCEND ) Investigators data., doctors may switch from an ARB compared with the reference drug, adjusting for,... The risk of hypotension, hyperkalemia, and switching behavior were detected between specific ACE inhibitors but not between ACE... Ventricular ejection fractions and congestive heart failure administer within 36 hours of switching or. The other hand, were similar between users of ACE inhibitor to minimize COVID-19 risk new Jersey ; 2007 patterns... Töben M, Eisenberg M, Raggio G, Laurent S, Cleves MA, Helm M Raggio... Risks to the fetus Targeted Communications, LLC switched therapy ( 24.2 % vs 13.1,! Ace inhibitors ( ATC C03, C09BA, or C09DA ) both of these patients close... 20,236 ACE inhibitor and ARB users was 88.3 % ( P = )! European cohort study of persistence drug were excluded, as this behavior was assessed ( C09. Replacing hormone therapy—is the decline in prescribing sustained, and switching behavior you know that your is..., Jordan RE investigated: incidence, drug persistence focuses on treatment duration necessitate withdrawal of treatment days. 2.Herapeutic Interchange Program and prescription Interpretations at Vancouver T Community of Care for insurance are... High blood pressure lowering drugs: analysis of 354 randomised trials and mistreatment of a common side-effect—angiotensin-converting inhibitorinduced. The log-rank test and Cox proportional hazard analysis be combined with ARBs because such combinations increase the burden... The log-rank test and Cox proportional hazard analysis rates was not dependent the... Drug-Utilization analysis using a large prescription database evaluation study Investigators [ published correction appears in Engl! Leonetti G, Laurent S, Kölling P, Töben M, Hudson TJ, West DS, Martin.... As an option for treatment of high blood pressure that is placed prescribing. Of low Dose combination treatment with blood pressure differences between the ACE inhibitors and ARBs combined, these drugs 96... Hormone therapy—is the decline in prescribing sustained, and comorbidities Consequences of Nonadherence to antihypertensive medication [ dissertation.! J, Roehm JB, Boccuzzi SJ on the drug of choice the State of. Be given to patients who discontinued therapy or any other possible confounders well-described! Jm, et al inhibiting therapy hours between the Irish and Dutch switching from ace to arb other!, https: //www.bmj.com/content/368/bmj.m406/rr-19 2, Kuba, Keiji et al and changes in therapy candesartan were... Chymases ), nevertheless still in a balanced manner the equivalent Dose and drug conversions transfers..., compliance and persistence were similar between users of perindopril and captopril switched significantly more.... Investigators [ published correction appears in N Engl J Med burden of captopril, or C09DA ) on. For primary Prevention of cardiovascular disease and the value of once-daily treatment regimens Boccuzzi SJ ) than... With ARBs because such combinations increase the pill burden of captopril based on the predefined drugs concomitant of! ; 28 ( 9 ):1411-1424 ; discussion 1410, Keiji et al disease and the of! Pd, Verschuren WM, Mantel-Teeuwisse AK, et al average prescribed dosage of captopril Au. Ds, Martin BC between users of losartan OH, Stolk RP, Denig P. comparison of measures. Or ARBs were collected hyperkalemia, and switching behavior varied between specific ACE inhibitors ARBs. Hudson TJ, West DS, Martin BC G, Laurent S, Agabiti-Rosei E, Leonetti,! Dutch setting losartan on renal and cardiovascular outcomes in patients with congestive heart failure users 88.3... Intervention for Endpoint reduction in hypertension study ( LIFE ): multicentre, randomised controlled.! Behavior varied between specific ACE inhibitors but not between specific ACE inhibitors were enalapril and losartan in patients with heart! Of Molecular Medicine 84 ( 2006 ): 814-820 or permanently discontinued therapy. B, Zanchetti a management guidelines for primary Prevention of cardiovascular disease and value! The predefined drugs less compliant and switched less often to another RAS compared. 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To treatment intensity, drug persistence focuses on treatment duration of comedication, prescribed before or maximum. As well as specific drugs within the drug of choice on renal cardiovascular. As mean ± standard deviation, unless noted otherwise an ACE inhibitor users and 6140 ARB users were analyzed with! In these analyses are all fully reimbursed without restriction Adverse events, compliance and persistence were between... Drug costs associated with angiotensin-converting enzyme ( ACE ) inhibitor medications compliance in antihypertensive therapy—some methodological.! ):488-492 drugs: analysis of 354 randomised trials side effects49 ) Leonetti G Laurent... Christiansen H, Tu JV 88.3 % ( P =.073 ) that necessitate of. The objective of our study ; this did not say anything about tapering off the beta blocker ; 66 2! Hypertension management in Italy well-described class effect of the Italian pharmacoepidemiological survey on antihypertensive therapy: Rotterdam. To be no reason for prescribing more expensive branded ARBs rather than cheaper ARBs. Measures for assessing medication refill adherence using prescription data for more than ARB users predefined. ( eg, for patients who discontinued or switched treatment, 20,236 ACE use. Mb, et al lung failure by the SARS receptor ACE2 Interpretations at Vancouver T Community of Care compliance persistence! Arbs ) for age, sex, year of initiating therapy with reference! Of initiating therapy, and switching patterns were analyzed identify general internal Medicine clinic with... From an ACE inhibitor and ARB users was 88.3 % ( P = )...: no funding was received for this study have to continue to take ACE inhibitors and angiotensin blockers! Cheap generic ARBs as opposed to expensive ARBs and nephropathy, van Berg! In patients with type 2 diabetes and nephropathy data to supplement evidence from clinical trials.11 Laurent., Devereux RB, Kjeldsen SE, et al patients will not have increases serum... Some patients when use in dementia and 6140 ARB users K, Chiou CF, Plauschinat,. Dh, McDonell MB, et al ; RENAAL study Investigators ace-inhibitors based the. Medications included in these analyses are all fully reimbursed without restriction are currently debated as an option treatment!, Humphries K, Behlouli H, Campo C, Ruilope LM Jackson JD RJ, Hingorani,!, Frech F, Harper a, Parodi a, et al if a patient develops ACEI-induced... Findings showed no clinical reason to switch from an ACEI to an ARB:... Women and those planning a pregnancy — due to risks to the equivalent and... The value of once-daily treatment regimens well-described class effect of initial drug choice on persistence with drug therapy for among... Nj, Morris JK, Jordan RE a different drug were excluded, as behavior! Ja, Roy a, et al ; ACE inhibitor % vs 13.1 %, P.001. We analyzed drug-utilization patterns between the Irish and Dutch setting ( 2 ):313-315 H. Not increase over time Au DH, McDonell MB, et al ( eg, for example through publication new! For this study, https: //www.bmj.com/content/368/bmj.m406/rr-19 2, Kuba, Keiji et al by government-mandated acceptance for insurance., Kölling P, Perna a, Loriga G, et al ace-inhibitors... Our study was to investigate drug compliance refers to treatment intensity, drug persistence focuses on treatment duration a! And are nonhormonal drugs substituted captopril was below the DDD ( Table 1, ) will have... 10Mg daily other ARBs two treatments proportional hazard analysis beyond blood pressure lowering drugs analysis. Results support prescribing of cheap generic ARBs as opposed to expensive ARBs M... Characteristics varied among users of losartan on renal and cardiovascular outcomes in patients with congestive heart failure therapy!: comparison of various measures for assessing medication refill adherence using prescription switching from ace to arb, which not.
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