The answer is: none.
Trials comparing ACE-inhibitors and CCBs did never find a specific advantage of one class over the other, since these drugs have effects beyond the blood-pressure reduction.
CCBs have shown to be better in reducing stroke, whereas ACE-i prevent cardiac remodeling and worsening renal outcomes, so, when a single-drug therapy is indicated, the decision should rely on other characteristics (i.e., race, medical history of previous myocardial infarction ecc).
Also, according to the results of the ACCOMPLISH trial, it seems that the best tratement is by combining ACE-i and CCB whenever a duble-drug therapy is indicated (which is almost 50% of hypertensive patients you see in the clinic at first medical evaluation).
I start treatment of hypertension with a low dose diuretic. It is as effective for primary and secondary prevention of complications of hypertension as other medications, is well tolerated, is given o.i.d.(f.i. 12.5 mg chlorthalidone), is very cheap and has an additive or even synergic effect with other blood pressure lowering medications.
CCB, specially Amlodipine is potent vasodilator than ARB. When, stage II or severe HTN, combination is more effective.
It realy depend of the patient profile(race, age and comorbidities)! Generaly ACE-i is not efficient when used alone but added with CCBs it gives better résults. CCBs Can be effective alone in elders people without comorbidities ! But we should also Care about adverses effects off this drugs and don't forget people with gout for whom Angiotensine II receptors inhibitors are better than ACE-i.
If the patient has diabetes then the ACE/ARB's are better. If there is no diabetes, then I prefer CCB's because of their anti-atherosclerotic effects. (Remember that the only reason to treat hypertension is to avoid atherothrombotic disease [ATD}.)
@ W. Feeman.
You also treat hypertension to prevent heart and renal failure.
I include heart failure within the ATD category, but I stand corrected about renal failure. Obviously you are correct. I always monitor renal functions in my patients and few get any degree of renal failure at any age, though more likely in the very old. I appreciate your allowing me to explain. I won't make that mistake again.
BTW, in ALLHAT, giving an ACE as solo medication for African Americans resulted in a higher incidence of stroke.
- Badges
- Science method