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
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
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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]
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]