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Does the 2023 ESH guideline support the use of ARB´

Does the 2023 ESH guideline support the use of ARB´s 1st line in hypertensive patients with stable coronary artery disease?

The New 2023 ESH Guidelines are straightforward; antihypertensive treatments are recommended to prevent CAD effectively. ACE has been shown to reduce CV outcomes in high CV-risk patients, including patients with CAD in RCTs, which supports their use in CAD as part of the antihypertensive combination therapy unlike ARB´s 2. ACE inhibitors were deemed more effective in decreasing the incidence of myocardial infarction, cardiovascular death, and all-cause mortality in patients with hypertension and diabetes. Combining with a BB improves prognosis and should be prescribed unless contraindicated.

Fig “1 Treatment of hypertensive patients with coronary artery disease (Page 107 of the ESC 2023 guidelines)

The single-pill combination of bisoprolol and perindopril has been shown to reduce blood pressure and HR in patients with hypertension and stable CAD. Additionally, the beneficial effects of the SPC on these risk factors were accompanied by improvements in angina symptoms and quality of life 2. Click here to read more.
Link to the ESC 2023 guidelines PDF.


1. ESG 2023 guidelines. 2. STYLE study
3. ACE inhibitor and ARB therapy: Practical recommendations.
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