Angiotensin Receptor Blockers Increase Risk of Myocardial Infarction

[ACE28]

Flowergirl,

I think the patents on many ARB's will be expiring soon, and a new drug is necessary for profit. The idea of an ARB with new properties and added benefits, may make many re-gain confidence with ARB'S. This new pill appears to be IRBESARTAN (AVAPRO) with added properties. If the ARB class really proves to be disastrous for cardio-protection, the addition of these special endothelial properties may not carry much weight. I believe many of the existing ARB's already share both the same and different properties which may prove effective and differentiate some from the others. In research studies BENICAR was found to have some ACE properties, improved endothelial function, reversed arterial plaque and reduced CRP and fibrinogen.
MICARDIS shared some of these same benefits, and improved glucose/insulin.
Will these 2 pills be the exception from the rest of the class?? Only more research will tell. According to most medical journals and research, only diuretics (the most studied) appear to effectively lower BP, improve heart failure, eliminate fluid retention, prevent weight gain and prevent strokes and MI. Maybe I should get rid of all my meds and ask my doctor for a prescription of INDAPAMIDE or some other diuretic, which costs about $12.00
a month, versus $400.00 for the newer designer BP meds which may not be helping us at all...

[flowergirl2day]

ACE,

Right on!

I haven't though of the patent expiration angle. It certainly puts things into a new perspective. To be honest, I haven't really read many of the ARB studies because I have a very low tolerance for this drug at the moment.
Thank goodness for diuretics. They do the job at little expense to the patients. Because of their effectiveness they are recommended as a first-line drug in an antihypertensive therapy and an add-on in the fancy combination drugs. I agree that their effectiveness has not been surpassed.

FG

[burpee]

It's been a long while since I read NEJM reports on ARBs vrs ACE medications but my understanding was that ARBs were no more beneficial than ACE medications.

The "problem" is that in addition to being no more beneficial, ARBs lacked some of the inherent "positive" cardiovascular related effects of ACE preparations.

My understanding was that the studies concluded that it would be a mistake to think that ARBs are a good substitutes for current ACE users and that health providers should not conclude that "newer is somehow better" with respect to this new class of drug.

[flowergirl2day]

burpee,

Based on what I've read, I agree with you completely. The ARBs have been helpful in treating patients with certain diseases but in my opinion are not an equal substitute for ACE inhibitors. An example: ACE inhibitors are used to slow the progression of kidney disease. Some patients (with bilateral renal artery stenosis, for instance) cannot take ACE inhibitors because that could result in kidney failure. This is when ARBs are substituted for the ACEis. While ARBs also possess renal function protective properties, they are not a first line medication. People with diabetes are prescribed ACE inhibitors to delay or help prevent diabetic nephropathy. ARBs are prescribed only in those instances when the ACE inhibitors are contraindicated.

flowergirl

[ACE28]

According to the authors of the ARB study, 9 out of 11 rather large ARB trials showed no protection at all for MI and worse an increase of about 20% for ATACAND and DIOVAN (though there was some stroke prevention). In the majority of ACE trials (approx. 90%) MI risk was cut by about > 20% along with improvenments accross the entire spectrum for kidney protection, stroke and all cause mortality...

P.S. I'm also aware that many trials cannot be relied on. Statistics can easily be slanted. Research trials prefer to report only the positive information or the main trial goals. ex. If a trial was set up to determine the stroke risk for an ARB versus ATENOLOL, The trial will conclude by stating that the ARB cut the stroke risk by 18 % and improved quality of life. If the ARB did worse, they can choose to scrap the whole trial for other reasons etc.. Oh' and by the way, If ATENOLOL was shown to cut the heart failure and MI risk by 35% versus the ARB, that will never be mentioned or stated because that was not the purpose of trial. (The trial was set up to determine stroke prevention).
If the ARB proved to be better in any category ex. better vision, no weight gain etc... You can be sure the pharm.company would like that information mentioned and available for the "health and benefit" of the general public.
With the following statement "Though this research trial was not powered to test these concerns we found...... blah blah blah" If other information reveals negative information such as an increase risk of 45% for bladder and colon cancer. DO NOT REPORT OR MAKE AVAILABLE to the public. Besides, that is not what this research trial was powered for. TRUE HUMAN COMPASSION AND BUSINESS ETHICS (don't make me laugh)

Forgetting the ill will and unethical practices of the large pharmacopea...and percentages etc... I think we can at least conclude that several very sharp (ethical) researchers decided to review all pertinent data on both the ARB's and ACE's and determine if the medications are beneficial, prolong survival, decrease survival or do nothing at all. Their main purpose was to make the public aware that these drugs are not necessarily interchangeable and that all drug information which affects our lives should be known. (I strongly agree that we have a right to know all information about a pill) When the researchers concluded that almost every ARB trial had large numbers of heart attack's versus placebo (forgetting other classes of medications) I think it was clear that a placebo pill would have been much better to be taking if you had to participate in this trial..