Angiotensin Receptor Blockers Increase Risk of Myocardial Infarction

[ACE28]

ARB's (DIOVAN/ATACAND/AVAPRO etc)and Calcium Channel Blockers (CARDIZEM/PROCARDIA etc..) are still being mentioned in many current news articles as increasing the chance for heart attacks. (Reported by some of the worlds most respected Medical Journals) These articles can be easily found.
The original article which appeared 2 years ago can be found on some previous threads. Research is concluding that the safest and most effective medications for life saving results are Diuretics and Beta Blockers and/or ACE INHIBITORS (CAPOTEN/ALTACE/ENALAPRIL/ACEON etc...)

[FRG03]

Any kind of drug will lead to another problem and it will always be like that. Why not try the alternative medicine ie. diet, excersice.... Doctors these days dont know what patient teaching is thats why most of their patients complications leads to another.

[flowergirl2day]

Ace,

ARB's (DIOVAN/ATACAND/AVAPRO etc)and Calcium Channel Blockers (CARDIZEM/PROCARDIA etc..) are still being mentioned in many current news articles as increasing the chance for heart attacks. (Reported by some of the worlds most respected Medical Journals)

Unfortunately you're right. Our doctors will keep prescribing this medication unless the FDA issues a warning or an alert regarding these possible adverse effects or takes an even more drastic action. Because nothing has been done in the years that have passed since the initial CCB controversy began, the chance of any intervention by the FDA is highly unlikely.

Much has been written in medical literature about the outcome and analysis of the study you mention and its many limitations. While it was indeed a very controversial issue at one time, much has changed. A post-hoc analysis of ALLHAT showed that, if anything, CCBs are safer and better tolerated than ACE inhibitors. (Personally, I have some doubts about that) .

Many other studies followed with the intention of setting the record straight either way. These subsequent studies managed to put an end to the controversy thanks to (supposedly) an overwhelming evidence showing the CCBs to be safe and effective. There are many doctors who remain unconvinced and have reservations about the safety of this group of medications. Some say it is unfair to attribute the increased frequency of adverse cardiovascular events to the entire class of CCBs because the drugs it consists of are completely different, thus the whole class should not be blamed for any possible shortcomings of a single drug belonging to it. Others say there had never been any problems with this class of medications to begin with. Meanwhile, what is one supposed to do? The beta blockers are not equivalent to the CCBs. They share certain characteristics, yet cannot completely replace the CCBs. It would be nice to have a SAFE alternative. One has to decide which is potentially the lesser evil (the risk-benefit ratio) - taking the medication or NOT taking it. I guess it is up to our doctors to make that judgement call.

flowergirl

[ACE28]

Hi Flowergirl,

The research concluded for ARB's is that they may prevent strokes and kidney failure similar to Ace Inhibitors, but they do nothing (or possibly harm)for heart protection. ALTACE, CAPOTEN, ACEON and most other ACE's decrease mortality and MI's by as much as 30%. (a dramatic reduction) ARB's were slightly worse than placebo and worse or equal to Calcium Blockersockers for MI protection. Considering that Calcium Blockers (amlodipine and almost all other "dihydropyridines" according to the articles)
have only helped lower blood pressure and Angina type pain without much mortality benefit, for ARB's to compare so poorly with Calcium blockers
tells you someting is very wrong.

NOTE: MICARDIS (Telmisartan) is showing (from their last large trial called ONTARGET that they are equal to RAMIPRIL) Am I sure about this??? and BENICAR and several others have really not been researched at all compared to the others and have no other indication other than HBP. I believe if a pill
is effective it should be tested in a larger numbers of patients.

[flowergirl2day]

Ace,

you are right! ARBs are still being studied and we will have to wait for a final verdict. The way I see it, those of us who need medications to keep our blood pressure down will have fewer meds to choose from once all the research has been finalized. Remember the recent controversy about beta blockers and the resulting recommendations and amendments to certain hypertension treatment guidelines? Then there were the still somewhat controversial (in some people's minds, if not within the entire medical community) calcium channel blocker findings, now these angiotensin receptor blocker studies...I think we cannot take everything at face value. If we do, we'll severely limit our treatment options. I guess we should think about what our medications help us prevent - in that context, things (including the side effects) do not seem so overwhelming. When it comes right down to it, the best medication is NO medication.

The new blood pressure drug undergoing clinical trials-DARA PS433540- has two modes of action - one of them as an angiotensin receptor antagonist and the other as an endothelin1 activity blocker. Hopefully, it will come through the second trial phase with flying colors and will eventually prove to be superior to the ARBs.

flowergirl