Agents

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

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Indications

• Congestive Heart Failure (CHF) (see Congestive Heart Failure, Congestive Heart Failure)
• Diabetic Nephropathy (see Diabetes Mellitus, Diabetes Mellitus)
• Hypertension (see Hypertension, Hypertension)
• Prevention of Alzheimer Disease/Prevention of Alzheimer Disease Progression (see Alzheimer Disease, 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

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Contraindications

• Pregnancy (see Pregnancy, Pregnancy)
• xxx

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Administration

• PO

Concomitant Administration of ACE Inhibitors and ARBS

• Combination ACE Inhibitor and ARB Therapy Increases the Risk of Adverse Effects [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 [MEDLINE]
  • Recommendation: it is recommended to not use combination ACE inhibitor and ARB therapy

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Adverse Effects

Allergic/Immunologic Adverse Effects

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

Cardiovascular Adverse Effects

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

Endocrinologic Adverse Effects

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

Pulmonary Adverse Effects

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

Renal Adverse Effects

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

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Other Effects

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

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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]
• http://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]