High Blood Pressure Medications: ACE Inhibitors vs. ARBs

blood pressure meter and heart
Roni Shye
Roni Shye, PharmD BCGP BCACP, is a licensed pharmacist in the states of Florida, Ohio, and Pennsylvania.
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In the land of high blood pressure medications, ACE inhibitors and ARBs are considered first-line therapies. That means, if you are being medically treated for hypertension (or high blood pressure), you’re likely to be on one of these types of medications. ACE inhibitors and ARBs represent two groups of drugs that both treat hypertension, but they differ in how they work and what side effects you might experience.

What is hypertension?

Hypertension (aka. high blood pressure) is when the pressure in your blood vessels is too high. According to current standards set by the American Heart Association (AHA), normal blood pressure is 120/80 and high blood pressure is that measurement is over 140/90. You can find more information from the AHA on blood pressure here.

You don’t feel high blood pressure like you feel a headache. High blood pressure often has no signs or symptoms, so many people don’t know whether their blood pressure is high until they’ve had it checked. Yes, blood pressure may rise temporarily in certain stressful situations, but we’re talking about when it stays elevated for a long time. Chronic high blood pressure can be a big problem as it increases the risk for kidney disease, heart disease, heart attacks, strokes, and even death.

What are ACE inhibitors?

ACE inhibitor (or ACEI) stands for angiotensin-converting enzyme inhibitor. Examples include lisinopril (Zestril), benazepril (Lotensin), and enalapril (Vasotec).

ACEIs work by stopping the change of a natural substance in your body called angiotensin I to its evil twin angiotensin II. Angiotensin II is a vasoconstrictor and causes your blood pressure to increase which leads to high blood pressure. Stopping the change results in blood vessel relaxation and a decrease in blood pressure.

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What are ARBs?

ARB stands for angiotensin-receptor blocker. Examples include losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro).

ARBs also affect angiotensin, but they work by blocking angiotensin II from binding to the special area on blood vessels otherwise known as receptors. In the end, this also results in blood vessel relaxation and a decrease in blood pressure.

What is the difference between ACEIs and ARBs?

ACEI and ARBs work on the same pathway to stop high blood pressure, but each type of medication works at different spot in the process.

What is an advantage of using an ACEI compared to an ARB?

Cost. All ACEIs are available as generics, which means a lower cost for you, the patient. Several ACEIs are also available on many well known pharmacy generic prescription savings programs for as little as $4 for 30 tablets—benazepril, lisinoril, and enalapril are common examples.

Although several ARBs are now also available as generics, the cost can still be significantly higher than their ACEI counterparts.

What is an advantage of using an ARB compared to an ACEI?

Side effects. A common disadvantage to using an ACEI is their potential to cause a cough. The cough is a known and nagging side effect of many ACEIs.

Although ACEIs and ARBs work very similarly, ARBs DO NOT cause a cough, and are considered alternatives to ACEIs if you’ve tried them and they did not work for you due to the cough side effect.

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