ACE inhibitors - effective dose in primary hypertension

Last reviewed 05/2021

• ACE inhibitors - evidence regarding dose of ACE inhibitors in primary hypertension
  • a systematic review has been undertaken into the use of ACE inhibitors in primary hypertension (1)
  • important conclusions were:
    • most of the blood pressure lowering effect (about 70%) can be achieved with the lowest recommended dose of the drugs
    • no ACE inhibitor drug appears to be any better or worse than others in terms of blood pressure lowering ability.
      • a dose of 1/2 maximum dose achieved a BP lowering effect that was 90% of maximum
      • BP lowering effect of ACE inhibitors is modest; the magnitude of trough BP lowering at one-half the manufacturers' maximum recommended dose and above is -8/-5 mm Hg
        
        
• angiotensin receptor blockers (ARBs) - evidence regarding dose of ARB inhibitors in primary hypertension
  • a systematic review has been undertaken into the use of angiotensin receptor blockers in primary hypertension (2)
  • important conclusions were:
    • no clinically meaningful BP lowering differences between available ARBs
    • BP lowering effect of ARBs is modest and similar to ACE inhibitors as a class; the magnitude of average trough BP lowering for ARBs at maximum recommended doses and above is -8/-5 mmHg
    • 60 to 70% of this trough BP lowering effect occurs with recommended starting doses
    • a dose of 1/2 maximum dose achieved a BP lowering effect that was 80% of maximum dose

Reference:

• 1.Heran BS et al. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD003823
• 2. Heran BS et al. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD003822