Advertisement

Trends in ACEi and ARB expenditure: Compelling case for competition in generic drug markets

  • Jonathan A. Batty
    Correspondence
    Corresponding author at: Clinical Research Fellow, Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, Worsley Building, Level 11, Clarendon Way, University of Leeds, Leeds LS2 9NL, UK.
    Affiliations
    Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Worsley Building, Clarendon Way, University of Leeds, LS2 9NL, UK

    Leeds Institute for Data Analytics, Worsley Building, Clarendon Way, University of Leeds, LS2 9NL, UK
    Search for articles by this author
  • Marlous Hall
    Affiliations
    Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Worsley Building, Clarendon Way, University of Leeds, LS2 9NL, UK

    Leeds Institute for Data Analytics, Worsley Building, Clarendon Way, University of Leeds, LS2 9NL, UK
    Search for articles by this author
Published:November 19, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.027
      Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) inhibit the renin-angiotensin-aldosterone system (RAAS). The RAAS is an elegant cascade of vasoactive peptides that orchestrates key homeostatic processes [
      • Mentz R.J.
      • Bakris G.L.
      • Waeber B.
      • McMurray J.J.V.
      • Gheorghiade M.
      • Ruilope L.M.
      • et al.
      The past, present and future of renin–angiotensin aldosterone system inhibition.
      ]. In response to hypotension, hypo-osmolality or beta-adrenergic stimulation, the kidneys secrete renin, which cleaves circulating angiotensinogen to angiotensin I. Angiotensin converting enzyme (ACE) catalyses the conversion of angiotensin I into angiotensin II and hydrolyses bradykinin. Angiotensin II acts on AT1 receptors in the arterioles, kidney, adrenal cortex, and brain to stimulate vasoconstriction, sodium reabsorption and thirst; synergistically increasing blood pressure. Overactivity of the RAAS leads to deleterious cardiac remodelling after myocardial infarction and is central to the pathophysiology of hypertension, heart failure, diabetes mellitus and chronic kidney disease. As such, the development of drugs that inhibit the RAAS was a major strategic priority for pharmaceutical companies in the second half of the 20th century.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mentz R.J.
        • Bakris G.L.
        • Waeber B.
        • McMurray J.J.V.
        • Gheorghiade M.
        • Ruilope L.M.
        • et al.
        The past, present and future of renin–angiotensin aldosterone system inhibition.
        Int. J. Cardiol. 2013; 167: 1677-1687
        • Frank R.G.
        • McGuire T.G.
        • Nason I.
        The evolution of supply and demand in markets for generic drugs.
        Milbank Q. 2021; 99: 828-852
        • Fuentes A.V.
        • Pineda M.D.
        • Venkata K.C.N.
        Comprehension of top 200 prescribed drugs in the US as a resource for pharmacy teaching, training and practice.
        Pharmacy (Basel). 2018; : 6
        • Bian B.
        • Kelton C.M.
        • Guo J.J.
        • Wigle P.R.
        ACE inhibitor and ARB utilization and expenditures in the Medicaid fee-for-service program from 1991 to 2008.
        J. Manag. Care Pharm. 2010; 16: 671-679
        • Almadfaa R.O.
        • Wigle P.R.
        • Hincapie A.L.
        • Guo J.J.
        The utilization, expenditure, and price of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the US Medicaid programs: trends over a 31 year period.
        Int. J. Cardiol. 2022;
        • McMurray J.J.V.
        • Packer M.
        • Desai A.S.
        • Gong J.
        • Lefkowitz M.P.
        • Rizkala A.R.
        • et al.
        Angiotensin–neprilysin inhibition versus enalapril in heart failure.
        N. Engl. J. Med. 2014; 371: 993-1004
        • Fernando M.E.
        • Drovandi A.
        • Golledge J.
        Meta-analysis of the association between angiotensin pathway inhibitors and COVID-19 severity and mortality.
        Syst. Rev. 2021; 10: 243
        • Esler M.
        • Esler D.
        Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic?.
        J. Hypertens. 2020; 38: 781-782
        • Shephard E.A.
        • Nawarskas J.J.
        Nitrosamine impurities in angiotensin receptor blockers.
        Cardiol. Rev. 2020; 28: 262-265

      Linked Article