Introduction
This paper will examine how the Angiotensin-Converting Enzyme (ACE) class of medications compared to the Angiotensin Receptor Blockers II (ARB) class of drugs affect the prevention of recurrent stroke in an older patient with hypertension. The evidence will be reviewed, and the best decision will be made to treat a 69-year-old female patient with hypertension who had a recent stroke in march and is still having trouble with memory.
Clinical Question
The clinical question that will be explored in this research paper is, how does the ACE class of medications compared to the ARB class of medications affect recurrent stroke prevention in adults with hypertension?
Search Strategy
The search was conducted during November 21-25, 2022 in the Google Scholar system. As the keywords and phrases were defined following terms: “Angiotensin-Converting Enzyme”, “Angiotensin Receptor Blockers II”, “hypertension”, and “stroke prevention”. Each search term has been supplemented with relevant terms. The search results were limited to articles written in English and articles written in the last five years. The database searches were supplemented by a manual review of the references of relevant articles. As a result, additional sources were included in the research.
Examining and Finding the Best Evidence
Arterial hypertension increases the risk of stroke by 4-6 times. The risk group is the older generation. ACE class of medications and ARB class of medications are widely used for lowering blood pressure in treating hypertension and heart disease. The researchers supported the suggestion that ACEs are more effective than ARBs in reducing the risk of heart attacks and death from cardiovascular disease (Turner & Kodali, 2020).
It was recommended to use ACEs as first-line therapy and only switch to ARB medications if side effects occur. Data from the Progress study showed the combination of the ACE inhibitor perindopril plus the thiazide diuretic indapamide to be more effective at preventing recurrent stroke than perindopril alone (Turner & Kodali, 2020). Recent studies show ACEs and ARBs have comparable efficacy in cardiovascular mortality, myocardial infarction, stroke, and end-stage renal disease, with significantly lower drug withdrawal rates (Shahn, 2022). Thus, ARBs have a more significant safety profile than ACEs, especially concerning cough and angioedema.
Critical Evaluation of Evidence
All studies support the effectiveness of ACEs and ARBs in improving outcomes associated with cardiovascular disease, diabetes, stroke, and kidney failure. Recent studies, which cover the medical records of tens of thousands of patients in Europe, the USA, Korea, and Japan, confirm that patients are better able to tolerate ARB-class drugs (Shahn, 2022). They prove that the performance gap between ARBs and ACEs was unrealistic and most likely explained by generational differences in research (Rincon-Choles, 2019). There is insufficient data available to directly compare the effect of ARBs and ACE drugs on therapy in patients with a previous stroke. However, the consensus, based on extrapolations from previous studies, is that ARBs and ACE inhibitors are equal (Turner & Kodali, 2020). This view is reflected in the ACC/AHA/HFSA guidelines on hypertension.
Application of Evidence
The patient is a 69 woman with hypertension, who had a recent stroke in march and is still having trouble with memory. She is currently taking Valsartan 80 mg QD. According to the studied evidence (Rincon-Choles, 2019), the treatment prescribed by the doctor is adequate. Valsartan is an ARB class of medicine that is used to lower blood pressure to prevent strokes. Studies show that ARBs and ACE drugs are equally effective, while ARBs have fewer side effects. In addition, studies confirm that therapy with ARB drugs improves the cognitive functions of the brain (Yang, 2021). This is an important factor since the patient complains of memory impairment.
References
Rincon-Choles, H. (2019). ACE inhibitor and ARB therapy: Practical recommendations. Cleveland Clinic journal of medicine, 86(9), 608-611. Web.
Shahn, Z., Spear, P., Lu, H., Jiang, S., Zhang, S., Deshmukh, N. & Finkelstein, S. (2022). Systematically exploring repurposing effects of antihypertensives. Pharmacoepidemiology and drug safety, 31(9), 944-952. Web.
Turner, J. M., & Kodali, R. (2020). Should angiotensin-converting enzyme inhibitors ever be used for the management of hypertension?Current Cardiology Reports, 22(9), 1-8. Web.
Yang, W., Luo, H., Ma, Y., Si, S., & Zhao, H. (2021). Effects of antihypertensive drugs on cognitive function in elderly patients with hypertension: A review. Aging and disease, 12(3), 841. Web.