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

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 [ [1] 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 Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar ]. 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. The Utilization, Expenditure, and Price of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the US Medicaid Programs: Trends Over a 31 Year PeriodInternational Journal of CardiologyVol. 370PreviewAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are used for several indications including hypertension. Our aim is to evaluate the utilization, expenditure, and drug price of ACEIs and ARBs in the US Medicaid population. Full-Text PDF