Thread by @CochraneHTN

THREAD: Are we using ACEIs & ARBs properly? A TI Tweetorial

1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.

#MedEd #hypertension

2/6 BEST EVIDENCE on ARBs & ACEI for #hypertension

3⃣@CochraneHTN systematic reviews:

ACEs v ARBs for htn bit.ly/34vS0hu

BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX

BP lowering efficacy of ACEIs for htn https://t.co/u8dN378QAe

#MedEd

3/6 ACEIs over ARBS when considering HARMS 🤔

Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇

#MedEd #medsafety #ptsafety

4/6 LESS IS MORE when #prescribing 💊

Don’t use more than ½ maximum dose of ACEI. ↗️ doses do NOT meaningfully reduce blood pressure further. ½ of max dose of ACEI/ARB produces 90% & 80% of BP lowering of max dose, respectively.

#MedEd #hypertension

5/6 PRICES MATTER 💰💰

As drug classes, ACEIs & ARBs do not differ in blood pressure-lowering efficacy; no individual drug in either category is superior to others. The only known difference is price 🤔

#MedEd #hypertension #drugpricing

6/6 CHECK 💊 PRICES when #prescribing

90% of ACEI scripts in BC are for ramipril & perindopril. Cost can differ btwn equally effective 💊 in same class. In BC, 100 days perindopril 8mg = $65; equivalent ramipril 10mg = $23. Pill-splitting may save 💰, depending on price

#MedEd

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