Below is a copy of an e-mail alert sent to my patients with hypertension. It might apply to you! Check with your doctor.

If you have hypertension (HTN, high blood pressure), diabetes (IDDM, NIDDM) or congestive heart failure (CHF) with or without coronary artery disease (atherosclerosis) and with or without elevated cholesterol or triglycerides - LISTEN UP!!!!!!!!!

After careful consideration, I am NO LONGER recommending ARBs (angiotensin- renin blockers), EXCEPT in certain instances and these must be considered on a case-by-case basis.

This class of drugs, while helpful for some and even though it lowers blood pressure, may NOT actually prevent one of the major complications of high blood pressure - cardiovascular disease (heart attacks) and in fact may INCREASE the risk of having a heart attack! Here are the most common brands of this class of pharmaceuticals - none of which are generic and all of which are quite costly even with the co-pays of most insurance coverage:

candesartan (ATACAND), eprosartan (TEVETAN), irbesartan (AVAPRO), telmisartan (MYCARDIS), valsartan (DIOVAN), and losartan (COZAAR)

PLEASE remember some of you now using these drugs may STILL need to remain on them because of renal (kidney) disease associated with diabetes, congestive heart failure therapy or adverse reactions like an intractable cough, headache and allergies associated with another class of drugs (ACE inhibitors) typically used instead of ARBs.

ACE inhibitors (angiotensin converting enzyme inhibitors) are an older class of prescription medication that have been used worldwide for close to 30 years. Most of the brands can be purchased as generics and some are available at Wal-Mart. Costco, Safeway and Fry’s pharmacies for $4 a month or $10 for a three month supply which is most often better than your insurance copay. They treat hypertension, slow progression of renal (kidney) failure in diabetics, are used in congestive heart failure (CHF) and are associated with a DECREASE in the occurrence of heart attacks and strokes. Here are the brands and their generic names in the U.S.:

benazepril (LOTENSIN), captopril (CAPOTEN), enalapril(VASOTEC), fosinopril (MONOPRIL), lisinopril (PRINIVIL, ZESTRIL), moexipril(UNIVASC), perindopril(ACEON), quinapril (ACCUPRIL), ramipril (ALTACE), trandolapril (MAVIK).

Because these drugs (ACE inhibitors) are now off patent protection and available as generics, drug companies have been pushing ARB’s (much more profitable) and combinations of ARB’s with other meds that are already generic- sporting new names so that your doctor and you think one is really different from another and worth the high price which they are not.

WHAT TO DO IF YOU ARE ON AN ARB? CALL MY OFFICE. MAKE AN APPOINTMENT. LET’S REVIEW YOUR NEEDS AND MAKE A CHANGE IN DRUGS IF APPROPRIATE. DO NOT FREAK OUT!!!!!!!!!!! I HAVE BEEN ON AN ARB FOR A DECADE. I AM STILL BREATHING, BUT, BECAUSE I AM AT RISK JUST AS YOU ARE, I AM CHANGING TO AN ACE INHIBITOR JUST AS YOU MAY.

DO NOT STOP YOUR ARB UNTIL WE HAVE SWITCHED YOU BECAUSE THIS COULD BE VERY DANGEROUS!!!