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High blood pressure medicines show promise for treating heart disease

Two medications typically 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 the Agency for Healthcare Research and Quality (AHRQ).  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, lower risk of heart attack and 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. Knowing the risks and benefits of these medications will help patients and their doctors decide the optimal 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. Standard treatment of stable ischemic heart disease consists of a modification of diet, exercise, and medications that include aspirin, anticholesterol drugs, nitroglycerin, and beta blockers. While standard treatment usually alleviates chest pain, it is not universally successful in reducing risk of heart failure or heart attack.

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, nonfatal 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 do not 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. The report's findings will soon be available in plain-language summary guides for patients, clinicians, and policymakers. Summary guides and reports on numerous clinical topics can be found at http://www.effectivehealthcare.ahrq.gov.

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