Angiotensin II Receptor Blockers (ARB’s)

Agents

Candesartan (Atacand) (see Candesartan
Fimasartan (Kanarb) (see Fimasartan)
Irbesartan (Avapro, Aprovel, Karvea) (see Irbesartan)
Losartan (Cozaar) (see Losartan)
Olmesartan (Benicar, Olmecip) (see Olmesartan)
Telmisartan (Micardis) (see Telmisartan)
Valsartan (Diovan) (see Valsartan)

Indications

Congestive Heart Failure (CHF) (see Congestive Heart Failure)
Diabetic Nephropathy (see Diabetes Mellitus)
Hypertension (see Hypertension)
Prevention of Alzheimer Disease/Prevention of Alzheimer Disease Progression (see Alzheimer Disease) [MEDLINE]
- ARB use decreased the risk of Alzheimer disease/dementia (even when compared to lisinopril use)
- ARB use decreased the risk of progression of Alzheimer disease/dementia to nursing home admission and death
- The effect of ARB’s was dose-responsive and additive to that of ACE inhibitors
- Groups had similar degrees of blood pressure control, ruling this out as a confounding variable

Contraindications

Pregnancy (see Pregnancy)
xxx

Pharmacology

Angiotensin II Receptor Inhibition
- Vasodilation
- XXXX

Administration

Concomitant Administration of ACE Inhibitors and ARB’s (see Angiotensin Converting Enzyme Inhibitors)

Combination ACE Inhibitor and ARB Therapy Increases the Risk of Adverse Effects (Arch Intern Med, 2007) [MEDLINE]: including hyperkalemia, medication discontinuation due to adverse effects, worsened renal function, and symptomatic hypotension
- Combination ACE Inhibitor and ARB Therapy Does Not Increase the Rate of Malignancy (J Hypertens, 2001) [MEDLINE]
- Recommendation: it is recommended to not use combination ACE inhibitor and ARB therapy

Adverse Effects

Allergic/Immunologic Adverse Effects

Angioedema (see Angioedema)
- Physiology: class effect (common to all ARB’s)

Cardiovascular Adverse Effects

Hypotension (see Hypotension)
- Physiology: class effect (common to all ARB’s)
Syncope (see Syncope)
- Physiology: class effect (common to all ARB’s)

Endocrinologic Adverse Effects

Drug-Induced Hypoaldosteronism (see Hypoaldosteronism)
- Physiology: class effect (common to all ARB’s)

Pulmonary Adverse Effects

Cough (see Cough)
- Physiology: class effect (common to all ARB’s)

Renal Adverse Effects

Acute Kidney Injury (AKI) (see Acute Kidney Injury)
- Physiology: class effect (common to all ARB’s)
Hyperkalemia (see Hyperkalemia)
- Physiology: class effect (common to all ARB’s), due to drug-induced hypoaldosteronism
Non-Anion Gap Metabolic Acidosis (see Metabolic Acidosis-Normal Anion Gap)
- Physiology: class effect (common to all ARB’s), due to drug-induced hypoaldosteronism

Other Effects

ARB’s Do Not Increase the Risk of Malignancy [https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm257670.htm]
ARB’s Do Not Increase the Risk of Myocardial Infarction [MEDLINE]

References

Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction: a quantitative review of data from randomized clinical trials. Arch Intern Med. 2007;167(18):1930 [MEDLINE]
Risk of angioedema with angiotensin receptor blockers in patients with prior angioedema associated with angiotensin-converting enzyme inhibitors: a meta-analysis. Ann Allergy Asthma Immunol. 2008 Nov;101(5):495-9. doi: 10.1016/S1081-1206(10)60288-8 [MEDLINE]
Potential of antihypertensive drugs for the prevention and treatment of Alzheimer’s disease. Expert Review of Neurotherapeutics 8 (9): 1286. September 2008. doi:10.1586/14737175.8.9.1285
ONTARGET Investigators: Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547 [MEDLINE]
Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372(9638):547 [MEDLINE]
Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis. BMJ 2010; 340 (9): b5465. doi:10.1136/bmj.b5465 [MEDLINE]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm257670.htm
Angiotensin receptor blockers and risk of myocardial infarction: meta-analyses and trial sequential analyses of 147 020 patients from randomised trials. BMJ. 2011;342:d2234 [MEDLINE]
Effects of telmisartan, irbesartan, valsartan, candesartan, and losartan on cancers in 15 trials enrolling 138,769 individuals. J Hypertens. 2011;29(4):623 [MEDLINE]