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ARBs 'have edge over ACE inhibitors' for stroke

GPs may want to choose ARBs over ACE inhibitors in patients at high risk of stroke, results from a meta-analysis suggest.

The risk of a stroke in patients on ARBs was 8% lower than with ACE inhibitors, the analysis of data from six trials involving more than 50,000 patients found.

But there were no significant differences between the two classes of drugs in risk of heart attack, cardiovascular mortality or total mortality.

The analysis, of patients followed up for at a year, was published in the latest issue of the Journal of Hypertension.

The Italian researchers concluded the evidence favoured ARBs when the patients' risk of stroke was stronger than their risk of other cardiovascular events, for example in Asian patients or in those who have already had a cerebrovascular event.

Study leader, Dr Paolo Verdecchia, a researcher at the University of Perugia said: ‘ARBs have a specific, albeit small, effect against stroke, which may enhance cerebrovascular protection beyond the overwhelming one due to blood pressure reduction per se.'

Dr John Ashcroft, a GP in Ilkestone and vascular lead for Derbyshire County PCT, said he agreed there appeared to be a small benefit. ‘With these sort of studies its very hard to be sure that you are comparing like with like.

‘With ARBs still many times more expensive that ACE inhibitors I will be reluctant to waste such large sums of tax payers money for such a small benefit, even if it is real.'

But he added: ‘In 18 months time losartan goes of patent and the price will fall.

‘ARBs have substantially fewer side effects than ACE inhibitors and this study will support the increased use at that time.'

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