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Old 03-16-2010, 04:58 PM   #46
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

The only reason I would think of for using an ACE inhibitor forst is cost - the majority of people dont get capoten cough, so can get a very effective drug for dirt cheap. For the 1 or 2 out of 10 who do get side effects, the extra cost of ARB's then becomes worthwhile.

Here in Australia, beta blockers are rarely used for HBP any more, of course, they are still dished out by the bucket load for angina and other conditions.

I am very lucky, I take enelepril and a low dose diuretic every day, and have had no side effects at all, the only way I know I am taking it is that my BP is back to normal.

Compared to the old days when people took reserpine, methyldopa, clonidine and gunethidine, we are oh so lucky to have suck safe, effective, hastle free drugs avaliable. Horay for big pharma!

 
Old 03-17-2010, 07:00 AM   #47
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

ACE inhibitors and ARB appear to be superior drugs and relatively side effect free. Atenolol the most widely used beta blocker unfortunately appears to have very little benefit in hypertension causes diabetes and is difficult to take . One expert described the way many feel on that drug with the picture "TOO TIRED FOR LIFE" . Hooray for requiring good solid outcome data .

 
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Old 03-17-2010, 07:37 AM   #48
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

The NationalInstitute f Clinical Excelence in the UK now puts beta blockers in 4th place, behind diuretics, ACE/ARB's and CCB's

They are an agency tasked with defining best and most cost effective practice, they arnt hostages of the drug industry.

They say that most studies on beta blockers have been done with atenolol, that there isnt enough evidence on other betas blockers to make them a first or even second choice.

 
Old 03-17-2010, 07:43 AM   #49
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Quote:
Originally Posted by bigvince1 View Post
ARBS and ACE inhibitors have been shown to be equally effective in treating hypertension. The Verma editorial in the BMJ ;it was not even listed as a study; was criticized for cherry picking data and ignoring the two largest studies that where statistically powered to show differences. The study and it was listed as such in the BMJ published in 2005 " Angiotensin receptor blockers and risk of myocardial infarction: systematic review" McDonald looked at 19 different studies involving ace inhibitors and arbs with over 30,000 people and found no difference in MI rates between the ARBs and ACE . ARBS have equal effectiveness and less side side effects than ACE inhibitors .,.
Of course the Verma study was challenged. It had to be. The ARB's (at the time) were all BRAND NAME drugs, with no generic. A story like this would have surely put the big drug companies out of business. Generic ACE's, Enalapril or Capoten (which costs pennies), is far superior to DIOVAN or BENICAR (very expensive with no added health and far worse mortality benefits), for hypertension. ACE's are still the recommended 1'st choice by most doctors. ARB's have raised serious concerns in the medical circles, and even if the risks are the same as ACE's, It's a gamble to take them.

 
Old 03-18-2010, 08:26 AM   #50
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Verma"s s "study" I read it was an editorial. How do you study the effect of a therapy without actually looking at the data . ARBs have been shown at less equal to ACE inhibitors in several studies; and without the cough Since they both work in the same pathway that result should not be surprising.

 
Old 03-18-2010, 11:11 AM   #51
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

ARB's are slightly worse than placebo for an increase in heart attack risk. Odds are probably better with Atenolol, despite the 3% percent chance of increased glucose. Almost no drugs or class of drugs have been thoroughly studied to recommend one as more superior to the other. With the exception of Metoprolol/Toprol XL, Atenolol, Propranol and Ace Inhibitor's such as Aceon/Perindopril (EUROPA trial) and Altace (HOPE trial). In the Hope trial Rates of reduction of cardiovascular events in patients taking Altace reported
from the HOPE trial include 32 percent for stroke, 20 percent for heart attack,
26 percent for cardiovascular death, and 22 percent for all 3 endpoints combined. In Europa, After a mean follow-up of 4.2 years, perindopril reduced the primary endpoint (combined risk of cardiovascular death, myocardial infarction, and cardiac arrest) by 20 per cent compared to placebo in the total patient group. In the group of patients with unchanged SBP at the start of the study, the reduction of primary endpoint was similar compared with those patients who experienced a reduction in SBP at the start of the study. Regardless of blood pressure levels, Perindopril improved mortality. Over a four-year period Perindopril would stop 50,000 heart attacks or cardiovascular deaths for a country of 60 millions inhabitants. The ARB's are not equivalent to these large ACE outcome studies.

 
Old 03-18-2010, 05:03 PM   #52
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

I'll say it again - the National Institute of Clinical Excelence in the UK has recomended that ARB's only be used in patients who cant tolorate ACE Inhibitors - on the gounds of cost effectivenes.

Even if they are equal in reducing mortality and morbidity - why use a drug costing $200 per month when a drug costing $4 per month has the same effect. You either get "capoten cough" or you dont, there is no middle ground, if you dont, an ACE inhibitor is the right choice for you.

 
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