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Whats the Main difference in effects?
I believe that no large trials have compared the two and showed differences in clinical outcomes. However, pharmacologically, several differences exist:
ACEi only inhibits ACE-generated angiotensin, and block no other pathways. ARBs are also more potent inhibitors of AT1 signaling when compared to ACEi.
ARBs may also increase AT2 signaling, because they only block AT1. ACEi hinders the breakdown/conversion of many substances including bradykinin which of course give some patients a dry cough.
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