info on ARBs
Angiotensin-receptor blockers (ARBs) may be used instead of an ACE inhibitor when a person is unable to tolerate certain side effects of an ACE inhibitor.
How It Works
Angiotensin II receptor blockers inhibit a substance that causes blood vessels to narrow (constrict). As a result, blood vessels relax and widen (dilate), making it easier for blood to flow through the vessels, which reduces blood pressure. These medications also increase the release of water and salt (sodium) to the urine, which in turn lowers blood pressure as well.
Preventing the blood vessels from constricting helps improve blood flow, which reduces the backup of blood in the heart and lungs. It also decreases the pressure that the left ventricle of the heart must pump against.
Angiotensin II receptor blockers also act directly on the hormones that regulate sodium and water balance.
Why It Is Used
Angiotensin II receptor blockers can be used to treat heart failure or kidney disease from diabetes (diabetic nephropathy) in some people who cannot tolerate ACE inhibitors.
How Well It Works
Angiotensin II receptor blockers (ARBs) may improve symptoms of heart failure but have not been shown to prolong life.1 Until more research is completed, ACE inhibitors remain the first line of therapy for heart failure unless side effects of an ACE inhibitor cannot be tolerated.2 A recent study (ELITE II) showed losartan was not more effective than an ACE inhibitor but may have fewer side effects.3
ARBs reduce the amount of protein in the urine of people with type 1 diabetes. Studies are under way to find out if these medications also protect the kidneys from diabetic nephropathy. One initial study has shown that ARBs work as well as ACE inhibitors to protect the kidneys of people with heart failure.4
Side Effects
Low blood pressure is the most common side effect with angiotensin II receptor blockers. ARBs can also worsen kidney function and raise potassium levels.
ARBs may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, potassium supplements, certain diuretics, and lithium. If you are taking one of these medications, talk with your doctor before taking any other medications.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What to Think About
ACE inhibitors rather than angiotensin II receptor blockers (ARBs) continue to be the medication of choice for heart failure and diabetic nephropathy.5
Angiotensin II receptor blockers may increase potassium levels in the blood.
ARBs can worsen kidney function in people with reduced kidney function.
ARBs should not be used in pregnancy.
Angiotensin II receptor blockers may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, potassium supplements, certain diuretics, and lithium. If you are taking one of these medications, talk with your doctor before taking any other medications.
Side Effects
Side effects may include:
Cough. A cough is one of the most common side effects of ACE inhibitors. Most people find the cough to be a minor problem that they can tolerate in exchange for the benefits of this medication. If coughing is a severe problem, other medications can be tried.
Low blood pressure. Another side effect of ACE inhibitors may be low blood pressure, which may cause symptoms of dizziness, weakness, or fainting. People with low to normal blood pressure generally will be started on a low dose of medication and need to have their blood pressure monitored regularly.
Swelling. Swelling in the face, neck, lips, throat, hands, feet, or genitals rarely may occur when using ACE inhibitors. If swelling affects the face or throat, it can interfere with breathing. If this occurs, notify your doctor immediately.