This guide was created by reviewing the many research studies done on this topic. The information is provided here to help you make a decision about your choices based on the available evidence.
This picture shows what your coronary heart disease may look like. The arteries that bring blood to your heart muscle have become narrowed or blocked. When that happens, it is hard for blood and oxygen to get to your heart. When the vessel is blocked, you may feel chest discomfort (such as pain, pressure, or tightness) when you do any physical effort or exercise. Doctors call this chest discomfort “angina.”
People with coronary heart disease are at risk for serious problems, including:
Although there is no cure for coronary heart disease, some medicines can help protect you from heart attack, heart failure, or stroke.
Your doctor may ask you to take one or several medicines, such as:
Two other medicines—ACE Inhibitors and ARBs—have been studied to see if they can also help people with stable coronary heart disease from developing other problems. Both of these medicines lower your blood pressure and have been used to treat heart failure.
You and your doctor can decide whether you should add an ACE Inhibitor or an ARB to your other medicines by:
You and your doctor might want to add an ACE Inhibitor to your other medicines for coronary disease because:
There are four possible benefits to patients who add an ACE Inhibitor to their other medicines for coronary disease:
The two charts below compare the results over a 4-year period for 100 people who did and did not add an ACE Inhibitor to their other medicines.
For every 100 people taking other medicines for coronary disease without an ACE Inhibitor, 92 people will not die from a heart attack or heart failure over 4 years (happy face); 8 will die from these causes (sad face).
For every 100 people who add an ACE Inhibitor to their other medicines for coronary disease, 93 will not die from a heart attack or heart failure over 4 years (happy face); 7 will die from these causes (sad face).
That means that 1 additional person out of every 100 people (green happy face) will avoid dying of a heart attack or heart failure by adding an ACE Inhibitor to their other coronary disease medicines over 4 years. The amount of benefit is about the same for avoiding a heart attack, being hospitalized with heart failure, or needing surgery or another procedure to increase blood flow to your heart muscle.
Some people who take an ACE Inhibitor have these problems:
Some people who take an ACE Inhibitor and then have surgery to open a blocked blood vessel have more risk of:
You may be someone who does experience one or more of the side effects from an ACE Inhibitor. In that case, you and your doctor may decide to add an ARB to your other medicines instead.
Studies show that patients who add an ARB to their other medicines (because they cannot take an ACE Inhibitor) have a lower risk of either dying from a heart-related cause or having a nonfatal heart attack or stroke.
Some people who take ARBs can get too much potassium in their blood. This may cause problems with the heart beat or the heart’s rhythm. These problems appear to not be common. ARBs can cause angioedema and birth defects as well.
A research study has shown that taking both of these medicines does not help you any more than taking only an ACE Inhibitor. Adding both medicines can also cause more serious side effects, including:
There are many ACE Inhibitor and ARB medicines. These medicines are made by different companies. There are no major chemical differences among the ACE Inhibitor medicines or among the ARB medicines, but dose amounts and costs will vary.
The amount you will have to pay will depend on:
Most ACE Inhibitors and some ARBs come in a generic form. Generic medicines usually cost less than brand-name medicines.
Ask your doctor to help you choose a medicine that is most effective for you and best fits your budget.
You can lower your risk of heart attack, heart failure, or a stroke, if you:
Ask your doctor to help you set your goals and get started making these changes. MedlinePlus, a U.S. Government Web site, has many resources to help you.
The information in this guide comes from the report Comparative Effectiveness of Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease. It was produced by the University of Connecticut /Hartford Hospital Evidence-based Practice Center through funding by the Agency for Healthcare and Research Quality (AHRQ). Additional information came from the MedlinePlus Web site, a service of the U.S. National Library of Medicine and the National Institutes of Health.
Additional information came from a 2007 report titled Comparative Effectiveness of Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBs) for Treating Essential Hypertension, AHRQ Pub. No. 08-EHC003-EF, November 2007.
This summary guide was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, Texas.