ACE Inhibitors: Preferred RAAS Inhibitor in High-Risk Patients as Compared to ARBs

ACE inhibitors and angiotensin receptor blockers (ARBs) are pivotal in managing cardiovascular disorders by inhibiting the Renin-Angiotensin-Aldosterone System (RAAS). ACE inhibitors, first introduced with captopril in 1981, are often preferred over ARBs, especially for high-risk patients, due to their proven efficacy in reducing blood pressure, preventing heart failure, and protecting against chronic kidney disease and coronary artery disease. ACE inhibitors block the conversion of angiotensin I to angiotensin II, and preserve bradykinin, promoting vasodilation. While ARBs also reduce blood pressure by targeting the AT1 receptor, ACE inhibitors are more effective in reducing mortality and cardiovascular events, especially in diabetic and heart failure patients. Despite side effects like angioedema and dry cough, ACE inhibitors are recommended as first-line treatment in various conditions, including type 2 diabetes. This chapter explores the comparative efficacy of ACE inhibitors and ARBs, emphasizing the superior outcomes associated with ACE inhibitors in high-risk populations.