Overcoming Cough and Angioedema: Advocating for the Use of ARBs Over ACE Inhibitors.

Melanie Lam, Anelsa Beqo, Ricky Thumar

The Annals of pharmacotherapy 2022 Mar

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Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors have comparable efficacy, but ARBs have a preferential safety profile with particular regard to cough and angioedema. Although guidelines have historically advocated for ACE inhibitor use before ARBs simply because of earlier market entry, data accumulation, and generic availability, updated verbiage advises an "ACE inhibitor or ARB" recommendation, as opposed to the classic "ACE inhibitor then ARB" approach. Despite these updates, clinical inertia in favor of ACE inhibitor use before ARBs overwhelmingly remains. Prescribers and educators should consider an "ARBs only" mentality, especially in high angioedema-risk groups such as black patients.

Citation

Melanie Lam, Anelsa Beqo, Ricky Thumar. Overcoming Cough and Angioedema: Advocating for the Use of ARBs Over ACE Inhibitors. The Annals of pharmacotherapy. 2022 Mar;56(3):358-362