Prescribing Review- Prescribing of Drugs Affecting the Renin-Angiotensin System Print Options: Adobe Acrobat

Prescribing of cardiovascular drugs has increased by 82 % since 2000, when the National Service Framework for Coronary Heart Disease was published. This trend has been matched by increased prescribing of drugs acting on the renin-angiotensin system- that is, ACE inhibitors (ACEIs) and angiotensin-II receptor antagonists (ARAs). In Prescribing Costs in Primary Care, the National Audit Office estimated that £67 million could be saved by increasing the use of generic ACEIs in place of ARAs, which are more expensive and offer no advantage for most patients.1 ACEIs currently account for 72 % of prescribing but the proportion of prescriptions for ARAs has been increasing steadily (Chart 1). In the last three years, increases in cost have been limited by the introduction of generic ramipril, the leading ACEI (Chart 2). However, growth in prescribing of ARAs, which are more expensive than ACEIs, has continued to exert upward pressure on costs and ARAs now account for 65 % of total costs for this class. There is also a trend for increased prescribing of perindopril which, even generically, is more expensive than ramipril (see Prescribing Data). Although the licensed indications vary, ACEIs and ARAs are primarily prescribed for the treatment of hypertension and heart failure and for secondary prevention of cardiovascular events post-myocardial infarction. enlarg