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Out of the two pathways for lowering the blood pressure that is either by decreasing the release of renin by blocking the beta receptors or by using ace inhibitors.which one is better and why ?


In my opinion, Angiotensin receptor blockers (decreasing the release of renin by blocking the beta receptors) are superior to ACE inhibitors with respect to performance, precision of action, and side effects. From experience, I have taken ACE inhibitors and am currently taking an ARB. For me, the ARB is more effective at reducing and controlling my blood pressure.

Angiotensin II-receptor blocker (ARB) provide site-specific blockade of the effects of angiotensin II. These compounds are highly selective for the AT1-receptor subtype. Like angiotensin converting enzyme (ACE) inhibitors, ARBs intervene in the renin-angiotensin system (RAS) cascade, but their action is more specific as they affect the final step of this cascade - binding of angiotensin II to its receptor. It has been shown that they are as effective as the ACE inhibitors and other antihypertensive drugs in reducing blood pressure, and they have a great potential for the treatment of other cardiovascular and renal disorders.

ACE inhibitors prevent the formation of angiotensin II, whereas ARBs prevent the interaction of angiotensin II with tissue receptors. As angiotensin II may be formed by enzymes other than ACE, such as chymase, blockade of angiotensin II at cellular receptors represents a more effective and precise mechanism for inhibiting the renin-angiotensin system.

A major difference between ACE inhibitors and ARBs is the lack of effects by ARBs on bradykinin potentiation. This probably accounts for the fact that few patients receiving ARBs experience the characteristic 'ACE inhibitor cough', which occurs in 15-20% of patients treated with an ACE-inhibitor.

The more specific mode of action and a lack of interaction with the bradykinin system are clinically translated into a better tolerability for ARBs compared with ACE inhibitors, in terms of cough and angioneurotic oedema. In addition to the side-effect profile, AT1-receptor blockade should provide clinical benefits in terms of blood pressure reduction and end-organ protection as a result of effective inhibition of the negative effects of angiotensin II.

ACE inhibitors are not without benefit. Angiotensin Converting Enzyme (ACE) Inhibitors are used to treat heart failure. ACE Inhibitors are known as "vasodilators," which means the blood vessels dilate or open up. By dilating the blood vessels, ACE Inhibitors help to reduce the workload of the failing heart muscle commonly seen with heart failure.

ACE inhibitors are also available in generic form, whereas ARB is not. This gives ACE inhibitor medication a distinct advantage in the cost arena.