Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
The hypertension guideline that physicians follow is referred to as JNC-7 and was made available back in December 2003. As such it's been over 8 years since it was last updated, which is eons when it comes to medical literature, especially in the field of cardiovascular medicine, especially hypertension. JNC-7 tells us to use thiazide-type diuretics first-line in patients with uncomplicated hypertension without compelling indications for any other drug class.
I mention this because a meta-analysis was published early online 2 weeks ago in the European Heart Journal concluding that angiotensin-converting enzyme (ACE) inhibitors decreased all-cause mortality by 10% compared to other blood pressure lowering agents. The authors analyzed data from 20 randomized controlled trials, including mortality data for which 158,998 participants average age 67 years with 58% men were followed for 4 or more years. Interestingly, their cousin class, the AT1 receptor blockers (ARBs) had no effect on mortality. Their only benefit? Less likely to cause the dry ticklish cough associated with ACE inhibitors.
Armed with this study, I'll have to try harder to convince my patients complaining of a new onset dry ticklish cough coincident with starting an ACE inhibitor that they're better off over the next 4 or more years to take the medication and learn to tolerate the side effect rather than switching to another blood pressure lowering drug. Plus I'll start considering the use of ACE inhibitors as first-line agent in uncomplicated hypertension, even as I wait for JNC-8.
