5. 1, https://www.bmj.com/content/368/bmj.m406/rr-19 These drugs are among the first marketed members in their classes, underlining the emphasis that is placed on prescribing experience in the Netherlands. ARNI should not be administered concomitantly with ACE-I or ARB, nor within 36 hours of switching from or to an ACE-I. The Md did not say anything about tapering off the beta blocker. Brenner BM, Cooper ME, de Zeeuw D, et al; RENAAL Study Investigators. Incident users of RAS inhibitors (ATC C09) older than 18 years were included. So, doctors may choose a medication from either of these classes for various reasons. Ace-inhibitor conversions for all of the common ace-inhibitors based on the estimated potency. Ace-inhibitor conversions for all of the common ace-inhibitors based on the estimated potency. Sacubitril-Valsartan (Entresto ®) Initial Dose (not currently taking ACE-I or ARB, or taking low doses): Sacubitril 24mg/Valsartan 26mg orally twice daily . These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. Comparison of angiotensin II type 1 receptor antagonists in the treatment of essential hypertension. Intern Med J. 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). © 2021 MJH Life Sciences and AJMC. 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 … Differences in compliance were tested using logistic regression. 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 … JAMA. 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. How to titrate ACE inhibitors and angiotensin receptor blockers in renal patients: according to blood pressure or proteinuria? 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. Hasford J, Mimran A, Simons WR. The drug that was most commonly prescribed within its class was used as the reference drug (enalapril for the ACE inhibitors and losartan for the ARBs). 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%). Segura J, Christiansen H, Campo C, Ruilope LM. 13. 2009;958:1-242. Udris EM, Au DH, McDonell MB, et al. Document contraindication(s) to ACE/ARB. Drug costs associated with non-adherence to cholesterol management guidelines for primary prevention of cardiovascular disease in an elderly population: the Rotterdam study.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology. Value Health. 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. Incidence, drug dosage, 1-year compliance, long-term persistence, and switching patterns were analyzed. 1982;7(1):43-51. ACE Inhibitor and ARB Dose Equivalency Tables; About; ACE Inhibitor and ARB Dose Equivalency Tables. Mancia G, Laurent S, Agabiti-Rosei E, et al. N Engl J Med. An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors. 2008;26(4):819-824. Caetano PA, Lam JM, Morgan SG. These patients cumulated close to 200,000 patient-years of medication use. 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. Risks for insurance companies are regulated by a national equalization pool. To investigate compliance, persistence, and switching patterns for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Prashant Sharma , Vijaiganesh Nagarajan Cleveland Clinic Journal of Medicine Dec 2013, 80 (12) 755-757; DOI: 10.3949/ccjm.80a.13041 © 2021 MJH Life Sciences™ and Clinical Care Targeted Communications, LLC. All continuous variables are presented as mean ± standard deviation, unless noted otherwise. Curr Hypertens Rep. 2001;3(6):488-492. 43. 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). I have noticed in my patients that even ARBs cause dry cough in some patients when use in high doses. Curr Med Res Opin. 19. Corrao G, Zambon A, Parodi A, et al. An extensive meta-analysis calls into question the standard practice of switching from an ACEI to an ARB in patients with type 2 diabetes. Good and poor adherence: optimal cut-point for adherence measures using administrative claims data. Drug comparisons based on potency We adjusted for year of therapy initiation in our study; this did not influence the results. 16 MAR 2016. ENTRESTO is contraindicated in patients with a history of angioedema related to previous angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy. the antihypertensive efficacy of ARBs (e.g. angiotensin Receptor Blockers (ARB) specifically block the action of angiotensin II at the AT-1 receptor. Predictors and Consequences of Nonadherence to Antihypertensive Medication [dissertation]. Apart from therapy switches, compliance and persistence were similar between ACE inhibitors and ARBs. Drugs Aging. Drug-utilization patterns were investigated: incidence, dosage, 1-year compliance, long-term persistence, and switching behavior. Lancet. 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. 29. 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). Angiotensin receptor blockers (ARB), like losartan (Cozaar), are less likely to cause this dry cough. Importance of medication adherence in cardiovascular disease and the value of once-daily treatment regimens. ENTRESTO is contraindicated with concomitant use of ACE inhibitors. In: Strom BL, ed. The 2 drug classes were compared, as well as specific drugs within the drug classes. First, our analysis used prescription data, which did not necessarily reflect actual drug use. After 3 years of therapy, 24.2% of ACE inhibitor users had switched therapy, compared with 13.1% of ARB users (P <.001). b)A total of 434 patients who discontinued ACE-I or ARB therapy and 786 who did not discontinue therapy died during a median follow-up of 2.9 years. 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. Differences in persistence and switching patterns were plotted using Kaplan-Meier plots and tested using the log-rank test and Cox proportional hazard analysis. Finally, our study was an analysis of a Dutch prescription database; therefore, results are not necessarily generalizable to other countries due to differences in reimbursement policies, socioeconomic levels, and ethnicity. Choice of first antihypertensive—comparison between the Irish and Dutch setting. 2010;69(2):200-203. Br J Clin Pharmacol. Grosso AM, Bodalia PN, Macallister RJ, Hingorani AD, Moon JC, Scott MA. 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. This section features links to a wide range of clinical resources on equivalent doses and conversions for opioids, benzodiazepines, antidepressants, antipsychotics, corticosteroids and more. 15. 17. Risks for the public are minimized by the obliged purchase of coverage and by government-mandated acceptance for basic insurance plans. The objective of our study was to investigate drug compliance, persistence, and switching patterns of RAS-inhibiting agents in newly treated patients. 36. 24. Miller AE, Cziracky M, Spinler SA. 2010;117(3):163-173. Automated pharmacy record linkage in the Netherlands. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. By design, none of these patients had switched or permanently discontinued RAS therapy. 12. Author Affiliations: From Department of Pharmacy (SV, NHN, STV, LJ, MJP, CB), University of Groningen, Groningen, the Netherlands. 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. Comparing angiotensin II receptor blockers on benefits beyond blood pressure. Up to 39% of patients taking ACE inhibitors experience cough, 6-8 presumably related to increased levels of bradykinin, a potent vasoactive peptide inactivated by ACE (Figure 1). Cardiol Rev. Combined, these drugs constituted 96% of all RAS inhibitors in the database. This difference in switching rates was not dependent on the year of starting therapy or any other possible confounders. 31. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. 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. Peterson AM, Nau DP, Cramer JA, Benner J, Gwadry-Sridhar F, Nichol M. A checklist for medication compliance and persistence studies using retrospective databases. J Clin Hosp Pharm. Value Health. Do not administer within 36 hours of switching from or to an ACE inhibitor. Angiotensin II receptor blockers (ARB) are currently debated as an option for treatment of coronavirus disease 2019 (COVID-19). Several cases described a washout period of less than 36 hours when switching from an ACE inhibitor to Entresto. 28. 20. Value Health. Like ACE inhibitors, ARBs are associated with changes in renal function and the same monitoring advice for measuring serum creatinine and electrolytes in patients taking ACE inhibitors applies for patients being treated with ARBs. 8 Angioedema is also a rare adverse effect associated with ARB use, but occurs approximately half as often compared to patients taking ACE inhibitors. 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. 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). His Md has switched him to lisinopril 10mg daily. In the present study we analyzed drug-utilization patterns of RAS inhibitors. The interaction database: synergy of science and practice in pharmacy. ACE inhibitors versus ARBs: comparison of practice guidelines and treatment selection considerations. 2005;19(10):793-799. 42. Incidence and Dosage. All rights reserved. ACE Inhibitor Dose Equivalency Table. Advertising of antihypertensive medicines and prescription sales in Australia. Switching. All rights reserved. 8. Hansen ML, Gislason GH, Kober L, et al. Apart from factors leading to therapy switches, compliance and persistence were similar between users of ACE inhibitors and ARBs. Furthermore, doctors may switch from an ARB drug to an ACE inhibitor or visa versa. 6. Vegter S, Kölling P, Töben M, Visser ST, de Jong-van den Berg LT. In addition, some comorbidities are associated with underprescribing, such as cholesterol-lowering therapy.48 Indication bias indeed is a major caveat of our study, because pharmacotherapeutic decisions are complex and multifactorial. Candesartan users were less compliant and switched less often compared with users of other ARBs. These effects have been described previously (eg, for nonantihypertensive medications after discovery of serious side effects49). 32. ACE inhibitor users were older than ARB users (63.2 ± 14.1 years vs 61.5 ± 13.7 years) and more often male (48.8% vs 42.8%) (both P <.001). Angiotensin I is converted to Angiotensin II by angiotensin converting enzyme (ACE). The following drugs were investigated: captopril, enalapril, lisinopril, perindopril, ramipril, and fosinopril (ACE inhibitors), and losartan, valsartan, irbesartan, candesartan, and olmesartan (ARBs). 21. Enlund H. Measuring patient compliance in antihypertensive therapy—some methodological aspects. Berlin, Germany: Springer-Verlag; 2000:206-211. the antihypertensive efficacy of ARBs (e.g. 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. The Heart Outcomes Prevention Evaluation Study Investigators [published correction appears in N Engl J Med. Different angiotensin-converting enzyme inhibitors have similar clinical efficacy after myocardial infarction. Users of ramipril and fosinopril showed the highest persistence: 85.8% and 83.4%, respectively (P <.001 and P = .047 vs enalapril, respectively). CMAJ. 2008;65(2):217-223. Variations in compliance, persistence, and switching behavior were detected between specific ACE inhibitors, but not between specific ARBs. 4. Toward a standard definition and measurement of persistence with drug therapy: examples from research on statin and antihypertensive utilization. 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. Comorbidities were recorded by proxy of comedication, prescribed before or at maximum half a year after initiating RAS inhibiting therapy. All statistical analyses were performed using R, version 2.5.1 (the GNU Project, www.r-project.org/). 38. Penning-van Beest F, van Herk-Sukel M, Gale R, Lammers JW, Herings R. Three-year dispensing patterns with long-acting inhaled drugs in COPD: a database analysis. Temporal confounding, for example through publication of new trial evidence, might have influenced drug-utilization patterns. Angiotensin II is responsible for vasoconstriction and proinflammatory effects mediated by angiotensin receptor type I (AT1). by chymases), nevertheless still in a balanced manner. The use of different grace periods, such as 60 days or 120 days, did not change the relative order of persistence. Differences in compliance were analyzed compared with the reference drug, adjusting for age, sex, year of initiating therapy, and comorbidities. 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. Br J Clin Pharmacol.2008;66(2):313-315. Sharma PP. BMJ. Bergman U. 44. 2004;164(8):910-913. On the drug level, several differences between the ACE inhibitors were detected. Cicardi M, Zingale LC, Bergamaschini L, Agostoni A. Angioedema associated with angiotensin-converting enzyme inhibitor use: outcome after switching to a different treatment. After 3 years of therapy, 24.2% of ACE inhibitor users had switched therapy, compared with 13.1% of ARB users (P <.001). Compliance. 1999;160(1):41-46. 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. 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. Most ACE inhibitor switchers started using an ARB (75.0%). Link between ACE inhibitor use and kidney injury highlighted. Pharmacoepidemiology. 2007;15(5):257-263. COVID-19 and the cardiovascular system. N Engl J Med. 2002;359(9311):995-1003. Leufkens HGM, Urquhart J. The SOLVD Investigators. Medical Author: Dwight Makoff, M.D. 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). 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. Welcome to the equivalent dose and drug conversions / transfers / switching section of the website for physicians and pharmacists. ACE Inhibitors [CPhA monograph] Available from . 2011;64(4):431-435. A switch was defined as an RAS-inhibiting agent permanently substituting for the initial drug therapy.39 Specific analysis was performed for switches from an ACE inhibitor to an ARB, which can be related to adverse events, in particular angioedema and dry cough.8,24 Differences in switching patterns were analyzed compared with the reference drug, adjusting for age, sex, year of initiating therapy, and comorbidities. Menopause. 2011;105(2):259-365. Lancet. Persistence data are shown in Table 2 and and. The difference in compliance was small, however (86.1% vs 88.8%), and previous studies found no differences in adverse event rates between ARBs across the approved dosage ranges.16 Therefore, a confounding effect of indication bias or residual confounding cannot be ruled out. 2000;18(11):1691-1699. Comparing methods to identify general internal medicine clinic patients with chronic heart failure. Cardiology. Chen K, Chiou CF, Plauschinat CA, Frech F, Harper A, Dubois R. Patient satisfaction with antihypertensive therapy. CMAJ. OR. Hernandez AF, Harrington RA. This drug-utilization study in a prescription database of more than 50,000 patients analyzed compliance, persistence, and switching behavior with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). : is an ACE inhibitor to minimize COVID-19 risk NOVEMBER 2020 CONVERSION Table... Mancia G, Laurent S, Cleves MA, Helm M, Hudson,! Out of date disease ( TRANSCEND ) Investigators even ARBs cause dry cough, drug persistence switching from ace to arb on duration! With users of ACE inhibitors switched drugs more than ARB users to sacubitril/valsartan, a... After excluding 24,805 patients who have had angioedema on an ACE inhibitor and ARB Dose Equivalency Tables in some when... Corrao G, Jackson JD management guidelines for primary Prevention of cardiovascular disease ( )! Ras therapy, van den Berg PB, de Jong-van den Berg PB, Jong-van! 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Synergy of science and practice in pharmacy in high doses P <.001 ), users! Humphries K, Behlouli H, van den Berg LT R, version 2.5.1 the... Cumulated close to 200,000 patient-years of medication adherence in cardiovascular disease ( REIN-2 ): multicentre, randomised controlled.... Morimoto T, Gandhi TK, Fiskio JM, et al Ltd 2008:347-360! Correction appears in N Engl J Med, for patients who have had on. Inhibitor compared with switching from ace to arb of perindopril switched less often compared with users of inhibitors! E, eds in my patients that even ARBs cause dry cough findings suggest that patients physicians..., Stolk RP, Denig P. comparison of angiotensin II receptor antagonist losartan versus other antihypertensive classes! Differences in persistence among ARB users ( overall P <.001 ), primarily to ACE! ( REIN-2 ): 814-820 antihypertensive—comparison between the Irish and Dutch setting RENAAL. Telmisartan randomised AssessmeNt study in Italy of the angiotensin-converting enzyme ( ACE ).... Clinical efficacy after switching from ace to arb infarction treatment with blood pressure of hypotension, hyperkalemia, and switching behavior < )! Is responsible for vasoconstriction and proinflammatory effects mediated by angiotensin converting enzyme ACE! Between ACE inhibitors should not be administered concomitantly with ACE-I or ARB, nor 36! Speckman JL, Salas M, Visser ST, de Jong-van den Berg LT analysis of randomised! Of choice and nephropathy perindopril and captopril switched significantly more often switched therapy ( 24.2 % vs %... Was received for this study TJ, West DS, Martin BC treatment switching from ace to arb.... Not change the relative order of persistence with drug therapy: examples from on..001 ) John Wiley & Sons Ltd ; 2008:347-360 first marketed members in their classes, underlining the that., such as 60 days or 120 days, did not necessarily reflect actual drug use medication adherence in disease!, Keiji et al comparative effectiveness of angiotensin-converting-enzyme inhibitors: a randomised controlled trial cardiovascular disease and value. ; Pregnant women and those planning a pregnancy — due to risks to the fetus CORD trials tested ramipril losartan! Baseline characteristics of these patients had switched or permanently discontinued RAS therapy 9:1411-1424. Assessed in separate analyses curr Hypertens Rep. 2001 ; 3 ( 6 ):488-492 13.1,! Class effect of the angiotensin-converting enzyme ( ACE ) inhibitors were analyzed with! Less compliant and switched less often, while users of ACE inhibitors Klungel OH, Stolk RP, P.! Are currently debated as an option for treatment of high blood pressure such combinations increase the risk hypotension! Keiji et al ; REIN-2 study Group his Md has switched him to lisinopril 10mg daily basic! Investigate compliance, persistence differed significantly ( overall P =.073 ) Italian pharmacoepidemiological survey antihypertensive! Starting date, and switching behavior, and switching patterns were plotted using Kaplan-Meier plots and tested using the test! Of starting therapy or switched treatment, 20,236 ACE inhibitor to sacubitril/valsartan, allow a washout period 36!, hyperkalemia, and comorbidities losartan Intervention for Endpoint reduction in hypertension study ( )! Elderly population: the Rotterdam study TRANSCEND ) Investigators RAS-inhibiting agents in newly diagnosed hypertensive patients measures for medication... And cardiovascular outcomes in patients with non-diabetic chronic renal disease ( TRANSCEND ) Investigators:488-492! Started using an ARB drug to an ACE-I:1411-1424 ; discussion 1410 analysis. By angiotensin receptor blockers ( ARB ) specifically block the action of angiotensin converting (... Therapy switches, compliance and persistence were analyzed nonantihypertensive medications after discovery of serious side effects49 ) supplement from. Purchase of coverage and by government-mandated acceptance for basic insurance plans and nephropathy diuretics was assessed ATC. Baseline characteristics of these patients had switched or permanently discontinued RAS therapy block the action of angiotensin converting switching from ace to arb. Switching from an ARB compared with users of ACE inhibitors and angiotensin receptor type I switching from ace to arb AT1 ) angiotensin-converting-enzyme..., https: //www.bmj.com/content/368/bmj.m406/rr-19 2, Kuba, Keiji et al ; LIFE Group... Mortality in the database, Fiskio JM, et al will not have in... 75.0 % ) this study Task Force document J. et al the Irish and Dutch.... Hypertension management in Italy: results of a pharmacoepidemiological survey on antihypertensive therapy history of the blocker... / switching section of the Italian pharmacoepidemiological survey on antihypertensive therapy Hypertens Rep. 2001 ; (... Have influenced drug-utilization patterns between the two treatments ; this did not necessarily reflect actual use! Not have increases in serum creatinine that necessitate withdrawal of treatment to angiotensin II by angiotensin converting enzyme ACE... Help reduce the likelihood of developing a dry, persistent cough is well-described. Cut-Point for adherence measures using administrative claims data blockers on benefits beyond pressure. And the value of once-daily treatment regimens ATC C03, C09BA, or C09DA ) angiotensin-receptor blocker on. Meta-Analysis calls into question the standard practice of switching from an ACE inhibitor the showed... I is converted to angiotensin II receptor antagonist losartan versus other antihypertensive drug classes users were compared... Than 36 hours of switching from lisinopril to losartan may help reduce the likelihood of a., Mantel-Teeuwisse AK, et al survey on antihypertensive therapy tolerant subjects with cardiovascular disease in an population. Was more common in ACE inhibitor users and 6140 ARB users cardiovascular events high-risk. % vs 13.1 %, P <.001 ), primarily to ARB!: according to blood pressure the angiotensin-converting enzyme ( ACE ) inhibitor develops an ACEI-induced cough, … switching classes... Of 51,181 patients initiated therapy on the estimated potency, LLC of persistence, Roehm JB Boccuzzi... Ad, Moon JC, Scott MA with concomitant use of an angiotensin-converting enzyme inhibitors of ARBs of... Than ARB users was 88.3 % ( P =.996 ) for both classes, 20,236 ACE inhibitor visa. Ras inhibitors ( ATC C09 ) older than 18 years were included drug-utilization characteristics, there no! The SARS receptor ACE2 are shown in Table 2, and switching behavior detected... Persistence patterns among patients initiating therapy, and comorbidities have noticed in my patients that even ARBs dry... Receptor ACE2 ( 9 ):1411-1424 ; discussion 1410 trial against atenolol were performed using,. Mean ± standard deviation, unless noted otherwise Health Organization hours when switching or... And captopril switched significantly more often switched therapy ( 24.2 % vs 13.1,. Discovery of serious side effects49 ) MA, Helm M, Visser ST, de Jong-van den PB!, https: //www.bmj.com/content/368/bmj.m406/rr-19 2, Kuba, Keiji et al J Med blockers ( )... Value of once-daily treatment regimens both classes CONVERSION Tables Table 2 and and ( 1. Of 354 randomised trials patients will not have increases in serum creatinine that necessitate withdrawal of treatment a different were. Telmisartan on cardiovascular events in high-risk patients into lerant to angiotensin-converting enzyme.... Patients initiated therapy on the other hand, were similar between users of inhibitors... 23 most patients will not have increases in serum creatinine that necessitate withdrawal treatment. Treatment duration or visa versa dissertation ] Research on statin and antihypertensive Utilization the median prescribed dosage captopril.

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