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High Blood Pressure Medicines show promise
for treating Heart Disease
Newswise — Two medications commonly used to
treat high blood pressure appear to be
effective in treating a common type of heart
disease known as stable ischemic heart
disease, according to a new comparative
effectiveness review funded by HHS’ Agency
for Healthcare Research and Quality. A
version of the analysis was posted in the
October 20 online version of the Annals
of Internal Medicine.
Treatment featuring the two medications –
inhibitors of angiotensin-converting enzyme,
or ACE inhibitors, and angiotensin receptor
blockers, or ARBs – can lead to a reduction
in death, risk of heart attack, risk of
stroke and fewer hospitalizations for heart
failure for patients suffering from stable
ischemic heart disease, researchers found.
However, the drugs have risks of their own.
Risks associated with ACE inhibitors include
a persistent cough, sudden fainting, too
much potassium in the blood, and dangerously
low blood pressure (hypotension). Risks
associated with ARBs include too much
potassium in the blood and low blood
pressure.
“Stable ischemic heart disease is a major
cause of death in the United States, so
these findings are very encouraging,” said
AHRQ Director Carolyn M. Clancy, M.D. “This
comparative effectiveness report will be a
useful tool for patients to help them work
with their clinicians to make choices on
treatment.”
Stable ischemic heart disease occurs when
the flow of oxygen-rich blood to the heart
is reduced because of narrowed or blocked
arteries.
Symptoms of stable ischemic heart disease
include decreased tolerance of exercise and
severe chest pain on exertion (known as
angina), which afflicts about 9 million U.S.
adults. Long-term risks of stable ischemic
heart disease include heart failure and
heart attack.
Overall, heart disease is among the nation’s
most common and deadly illnesses, afflicting
nearly 80 million Americans and killing
nearly 2,400 every day.
Standard treatment of stable ischemic heart
disease consists of a modification of diet,
exercise and medications including aspirin,
anti-cholesterol drugs, nitroglycerin and
beta blockers.
These can keep the disease from worsening.
However, while standard treatment usually
alleviates chest pain, it is not universally
successful in reducing risk of heart failure
or heart attack.
For patients with advanced stable ischemic
heart disease, treatment can include heart
surgery (coronary artery bypass graft, in
which surgeons use a blood vessel harvested
from the chest, leg or arm to reroute blood
flow around narrowed heart arteries) or
angioplasty (a procedure in which a catheter
is used to inflate a balloon inside the
plaque-narrowed artery and a mesh tube
called a stent is usually inserted to keep
the artery open).
ACE inhibitors and ARBs, which are commonly
prescribed to combat high blood pressure,
also are used for treatment of a heart
attack and chronic heart failure. Captopril
(sold as Capoten), the first ACE inhibitor
to be taken orally, has been commonly
available in the United States since the
early 1980s.
ARBs, first approved for use in the United
States in the mid-1990s, often are
prescribed when a patient has adverse
effects to ACE inhibitors, but ACE
inhibitors are used more commonly.
The AHRQ report found that patients with
stable ischemic heart disease who take an
ACE inhibitor in addition to standard
treatment can reduce the likelihood of
several negative outcomes, including death
from heart attack or heart failure,
non-fatal heart attacks, hospitalization for
heart failure, and revascularization
(surgeries that reroute blood to the heart).
Patients who take an ARB in addition to
standard medications can reduce their risk
of death from a heart-related cause, heart
attack or stroke.
While some patients and clinicians pursue a
course of treatment using both ACE
inhibitors and ARBs, the report found that
combined treatment does not show any benefit
over an ACE inhibitor alone and that risks
include fainting, diarrhea, low blood
pressure and kidney problems.
The report found that existing studies
provide few data on the medications’
benefits or harms in specific populations
such as people of different genders,
ethnicity, diabetic status or those who have
or don’t have high blood pressure.
AHRQ’s
new report, Comparative Effectiveness of
Angiotensin-Converting Enzyme Inhibitors or
Angiotensin II Receptor Blockers Added to
Standard Medical Therapy for Treating Stable
Ischemic Heart Disease, is the newest
research review from the Agency's Effective
Health Care Program.
That
program, authorized by the Medicare
Prescription Drug, Improvement and
Modernization Act, represents an important
federal effort to compare alternative
treatments for health conditions and make
the findings public. The program is intended
to help patients, doctors, nurses,
pharmacists and others choose the most
effective treatments. The new report’s
findings will soon be available in
plain-language summary guides for patients,
clinicians and policymakers.
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