ACE INHIBITORS versus ARBS for BLOOD PRESSURE CONTROL, Clinicians be careful with COMPARISON STUDIES. A camel has 2 HUMPS on its back.
This post about BLOOD PRESSURE is a little more technical than some of my previous posts, but an important VITAL reading measured in the Doctors/Dentist office and by that machine before you reach the pharmacist to pick up your medications is BLOOD PRESSURE.
Photo by Maxim Tolchinskiy on Unsplash
The three numbers that comprise a blood pressure reading are;
- Systolic (TOP number)
- Diastolic (BOTTOM number)
- Pulse (Your personal drummer)
Your BLOOD PRESSURE READING is a reflection of your personality and also of your PHYSIOLOGY. So
hopefully it makes sense that to help improve your blood pressure and pulse if they are too HIGH
or too LOW we would look to understand basic PHYSIOLOGY as our "Bloodhound Dog" of truth as to
what does 120/80 really mean? (Check out my lecture), before just comparing drugs such as ACE
versus ARBS for improvement of blood pressure, not realizing that any medication that is older
and cheaper in cost might not be all that BAD?
ACE inhibitors I have your back, as there is talk within the medical community to STOP USING ACE
inhibitors and only prescribe ARBS for blood pressure control. WHAT???
From "Basic Pharmacology" Any indirect receptor blocker is more effective than any direct
receptor blocker because the natural physiology one tries to block continues and exerts the
effect once the direct receptor blocker wears off. (Clonidine). An indirect blocker however will
disable the receptor site causing a permanent block of a physiological process. (Not necessarily
the desired effect we want for HTN). ACE inhibitors not only directly affect the physiological
"pathway" producing vasocontraction. (AG2/bradykinin), but they also affect the Aldosterone/NA/K
arm of HTN.
ACE inhibitors work well to improve systolic HTN with an increased pulse rate because the
elevated bradykinin levels drop the systolic BP while the elevated but WNL of Potassium will
decrease the pulse. This is what an ACE inhibitor does.
Photo by Testalize on Unsplash
The same elevated bradykinin levels with ACE inhibitors however have a potential to cause occasional dry cough or genetically based angioedema. If the unknown genetics of a patient increase the risk versus benefit profile of a patient , (Angioedema), with elevated systolic BP and elevated pulse there are so many options/combinations of medications to control systole AKA afterload with or without a normal pulse.
Clinicians, please use the patient's BP and pulse as your guide when setting the goal of
controlling/improving Systolic, Diastolic, Pulse. (Whatever the BP reflects is wrong). Blood
pressure is a reflection of physiology, (Afterload/Preload, pulse and personality). Basic
physiology states controlling points of a natural process is a lot easier than trying to
directly block the process unless you indirectly disable the receptor.
Camels still have 2 humps.
Photo by Dr. Colin Ross