According to the JNC-7 recommendations for the treatment of hypertensionguidelines treatment of most patients with hypertension will require the use of two medications.
A thiazide diuretic is recommended for most patients as one of the two medications, and addition of either an Angiotensin Converting Enzyme Inhibitor (ACEI) or and angiotensin converting enzyme blocking agent (ARB) is the second drug used most often by practicing physicians and is at the top of the list on the JNC-7 guidelines.
So how does your physician decide between an ACEI and an ARB? The ACEI medications have the most data to support their use in the treatment of hypertension and in the prevention of complications of high blood pressure, heart failure, renal failure, and diabetic nephropathy.
They are also almost all available as very inexpensive generic medications.
For both of these reasons most physicians choose an ACEI as the first blood pressure medication to add to the thiazide diuretic.
There are few serious side effects, and it's uncommon to have minor side effects of the ACEI meds.
A small percentage of patients will develop a persistent dry cough from the ACEI meds because their function to inhibit the conversion of angiotensin 1 to angiotensin 2 is on an enzyme located in the lungs.
A major indication for an ARB is development of a cough from an ACEI.
The ARBs are still mostly fairly expensive branded drugs, although losartan lost its patent and became available as a generic in 2010.
Most brand name ARBs cost in the $80-100.
/ 30 days range.
Most insurance plans have at least one of the ARB medications available on their tier 2 co-pay preferred medication list.
Sometimes an ARB gives a bit better reduction of blood pressure than the ACEI meds, but usually their efficacy in treating hypertension is pretty similar.
Both classes of medications can cause elevation of serum potassium in some patients, and in patients with significant obstruction of one renal artery they can lead to acute deterioration of renal function.
Otherwise these drugs are usually really well tolerated and when used with a diuretic are very potent and effective anti-hypertensive drugs.