ARB

“And Losartan or whatever ACE inhibitor or ARB inhibits your capacity to have high blood pressure.”

“There are other hypertensives that we use sometimes, but those are two mainstays. Which is so interesting because, I mean, we just don't use those outside of pregnancy at all because they're not that good. So does that mean we do not know or we do know that ACE inhibitors or ARBs, which would be first line in someone who's not pregnant, do we know for sure that those are not safe in pregnancy?”

“But here, if you overshoot this, you can cause some damage. The ARBs are right there on par with the ACE inhibitors. In fact, we did an internal white paper on this very recently. The consensus view is that basically across the board, the ARBs are probably slightly better drugs than the ACE inhibitors.”

“So, in every manner that we compare them in terms of efficacy and side effects, the ARB is as good, if not slightly better, than the ACE inhibitor. The ACE inhibitors have been around longer.”

“So, a lot of times people don't necessarily have a choice in them because their insurance company is going to pay for an ACE inhibitor. They're not going to pay for an ARB. But if ACE inhibitors are causing symptoms, such as a cough, which is probably one of the more common symptoms, you want to know that you have other agents there as well.”

“ARB and we still need more reduction. I think it's worth pointing out here, by the way, that these blood pressure-lowering medications by themselves are larger than any single lifestyle factor.”

“So, that's something you want to keep in the back of your mind. It used to be, I think, the dogma that anybody with diabetes should be on an ACE inhibitor over an ARB if you're going down that path. I would say when we looked at these data, which we did for our internal white paper, we didn't see a strong enough case for that.”

“And race might also play a role here. It would appear that in African-Americans, thiazide diuretics or calcium channel blockers might actually be more effective than ACE inhibitors or ARBs or even beta blockers when it comes to reducing cardiovascular events.”