Angiotensin II receptor blockers (ARBs)

Examples

Generic Name	Brand Name
candesartan cilexetil	Atacand
eprosartan	Teveten
irbesartan	Avalide [contains a diuretic], Avapro
losartan potassium	Cozaar, Hyzaar [contains a diuretic]
telmisartan	Micardis
valsartan	Diovan, Diovan HCT [contains a diuretic]

An angiotensin II receptor blocker (ARB) may be used instead of an angiotensin-converting enzyme (ACE) inhibitor if you are not able to tolerate certain side effects of an ACE inhibitor. Also, in people with type 2 diabetes and high blood pressure, ARBs are recommended in combination with ACE inhibitors as first-line treatment.¹

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 in some people who cannot tolerate ACE inhibitors or who have kidney disease from diabetes (diabetic nephropathy) and in people with type 2 diabetes.

ACE inhibitors can cause an annoying cough because they block the breakdown of a substance that can cause you to cough. ARBs do not block the breakdown of this substance, so they do not cause the annoying cough and are a good choice for you if you cannot tolerate ACE inhibitors for this reason.

How Well It Works

ARBs may decrease symptoms of heart failure when added to the usual therapy for heart failure, according to a recent study.² But if you take an ARB with an ACE inhibitor, you have a higher risk for kidney problems and for potassium levels that are too high. For this reason, you will likely need close monitoring.

ACE inhibitors remain the first choice of therapy for heart failure unless you cannot tolerate side effects of an ACE inhibitor.

For people with type 2 diabetes, ARBs reduce the amount of protein in the urine and protect the kidneys from diabetic nephropathy.³

Side Effects

Low blood pressure is the most common side effect with angiotensin II receptor blockers. Light-headedness and dizziness are the most common signs of low blood pressure. ARBs can also make kidney function worse and raise potassium levels.

ARBs may interact with non-steroidal 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 ARBs continue to be the medication of choice for heart failure and diabetic nephropathy caused by type 1 diabetes. ARBs are a relatively new class of medications for heart failure. They are not used routinely, but their use is expanding rapidly, especially for those with type 2 diabetes.

ARBs may increase potassium levels in the blood, may make kidney function worse in people who have reduced kidney function, and they should not be used during pregnancy. ACE inhibitors also have the same potential complications.

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Author:	Douglas Dana Robin Parks, MS	Last Updated: October 23, 2006
Medical Review:	Adam Husney, MD - Family Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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