text_1: New class of blood pressure meds as effective as old, analysis shows
text_2: This Washington Post story reports the findings of a study that compared the efficacy of two classes of drugs available to treat cardiovascular disease (CVD) — angiotensin converting enzyme, or ACE, inhibitors versus newer angiotensin receptor blockers, or ARBs. It involved a meta-analysis of more than 100 earlier studies monitoring more than a quarter-million patients who were at high risk for CVD. The results showed the two types of drugs to be equally effective with the major difference being a lower chance of side effects with the use of ARBs. With a bit more information on harms and a better grasp of the limitations of this study, the Post’s coverage is more solid than a competing HealthDay story that was based on a news release. But the story lacks voices other than that of the study’s lead author, and it doesn’t disclose the relationships that several of the authors have with the pharmaceutical industry. For patients with high blood pressure, there are numerous studies that demonstrate medications to lower blood pressure are associated with decreased rates of heart attacks, strokes and to a lesser extent, kidney failure. Given the number of different choices available from a range of classes of medications, how do patients and doctors decide on which to use? Here the comparison is between angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). When considering which agent to use for a given patient, a physician generally considers the relative benefits, harms and costs of the different agents, as well as any patient factors that may lead one class of agents to have particular advantages or limitations (for example, if the patient already has a high potassium level, use of either an ACEI or ARB may be problematic since they both raise potassium levels further). The current study seeks to address mainly the relative benefits of these two classes of medicines and glosses over harms and costs while not even mentioning patient-level factors. In terms of the benefits, the authors suggest that initial studies comparing ACEIs and ARBs were biased by the times in which the original studies used to justify approval were performed. Specifically, the older ACEIs studies came at a time when lifestyle and other medication options were more limited than the following decades when ARBs were studied. It is difficult to confirm or refute this assumption, but studies of these classes in a more comparable time frame would decrease bias associated with temporal trends. The current study adds evidence that these two classes are similar, but this isn’t really dramatically new information. Indeed, many guidelines suggest ACEIs or ARBs as being equivalent. The advantage of ARBs is better tolerability, as mentioned in this article, but the disadvantage remains cost. Though the article provides one line saying that with more generics available for ARBs, the cost difference has diminished, but even the cost of generics appear higher for ARBs than ACEIs. Thus, for many clinicians even an increased recognition of similar benefits may not lead to much change in practice given differences in costs