Comparing Blood Pressure Medicines

March 2, 2010

Today, it may seem easier to get information about a new oven or drill before you buy one than finding clear information about the medicine or treatment that's best for you. That shouldn't be the case, especially for common health conditions like high blood pressure.

More than 65 million Americans have high blood pressure, or hypertension. Most people with high blood pressure have no symptoms, but if it's left untreated, it can cause strokes, heart attacks, or kidney problems. That's why hypertension is called "the silent killer."

Some people are able to lower their blood pressure by losing weight, eating healthy, and becoming more active. But, if you're like most people, you may need medicines to control your high blood pressure.

Two common medicines to treat high blood pressure are ACE inhibitors (ACEIs) and so-called angiotensin receptor blockers (ARBs). Both relax blood vessels to help lower your blood pressure. About two dozen ACEIs and ARBs are available. Finding the right one for you depends on balancing the benefits, side effects, and costs. Having this information will help you and your doctor decide on the best drug to treat your high blood pressure.

My agency, the Agency for Healthcare Research and Quality (AHRQ) has developed a guide on blood pressure pills that compares ACEIs and ARBs. To develop the guide, scientists looked at the findings of about 60 studies to compare how these pills work for different patients. This research is called comparative effectiveness research. It focuses on a specific health condition and identifies the benefits and risks of treatments.

AHRQ's guide on blood pressure pills lays out the pros and cons of ACEIs and ARBs:

• Both ACEIs and ARBs, when taken regularly, do a good job of lowering blood pressure.
• Serious problems rarely occur with ACEIs and ARBs. Both types of pills can cause cough, dizziness, and headache. The chance of experiencing dizziness and headache is similar with both pills, but ACEIs are more likely to cause a dry cough that causes some people to switch drugs.
• Studies show that 8 of 100 people taking an ACEI stop taking it because of side effects, while only 3 of 100 individuals taking an ARB stop because of side effects. If you are taking one of these medicines and are having side effects, do not stop taking the medicine. Talk to your doctor or nurse.
• ACEIs and ARBs do not affect cholesterol or blood sugar levels.
• While brand-name ACEIs and ARBs have similar costs, some ACEIs are available as generics, which cost less. If your medicines are covered by your health insurance plan, find out how much you will have to pay so you can factor this in your decision.

AHRQ has sponsored comparative effectiveness research through its Effective Health Care Program for many years. The Federal Government is boosting funding for this type of work so doctors, nurses, and patients have good information to make better-informed decisions. In fact, AHRQ's guide on blood pressure medicines is just one of several available consumer guides.

Comparative effectiveness research does not make your choice for you. That decision is always left to you and your doctor. But having this information can help you understand the benefits and risks of treatments and then help you make a decision on the right balance for you. With this information in hand, you and your doctor can work together to make the best possible treatment decisions.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.