ACE Inhibitors vs ARBs: What’s the Difference?

by The GoodRx Pharmacist on July 31, 2014 at 2:47 pm

ACE Inhibitors and ARBS – these abbreviations may not look all that similar or even have any
meaning to you as a patient. However, 1 in 3 adults have high blood pressure and are likely on one of
these two types of medication even if they do not know it. Drugs in these classes have the same main
indication, hypertension (high blood pressure), but differ in how they work and their side effects.

What is hypertension?

Hypertension, also known as high blood pressure, is when the pressure in the blood vessels known
as arteries is elevated. According to the American Heart Association the current normal or standard
blood pressure goal is 120/80; blood pressure is usually considered high when over 140/90. You can
find more information from the AHA on blood pressure here.

Can I feel high blood pressure like I can feel when I have a cold?

Not really. High blood pressure often has no signs or symptoms which is why many people do not
realize their blood pressure is high until they’ve been checked.

You may hear people say that they can feel their blood pressure rising in certain situations or
circumstances which may be true, however, high blood pressure is a concern when it remains
elevated for a long time.

Are there complications that may arise due to high blood pressure?

Yes. Having uncontrolled high blood pressure may result in life-threatening complications like heart
attack, heart disease, stroke, and kidney disease.

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.

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.

ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors) act within the kidney's. The kidney's
produce renin. Renin is converted to angiotensis-I on into angiotensis-II. Angiotensin-II is a powerful
vasoconstrictor (causes your blood vessel diameter to be smaller). Angiotensin-II also secretes
aldosterone, which holds water and sodium in the kidneys instead of excreting them. This leads to
increased blood volume and high blood pressure. ACE Inhibitors prevent the conversion of
angiotensin-I to angiotensin-II.

ARB's (Angiotensin II Receptor Blockers) also work within the kidney. ARB's prevent angiotensin-II
from binding to its' receptor site, preventing blood vessel constriction and the secretion of
aldosterone.

ARB's are a newer class of high blood pressure medication and tend to be better tolerated. However,
it's best to work with your MD to determine the appropriate medication for your treatment.