Health Library Angiotensin II Receptor Blockers (ARBs)From Healthwise

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

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.

Angiotensin II receptor blockers can be used to treat coronary artery disease or 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.

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 coronary artery disease or 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

Low blood pressure is the most common side effect with angiotensin II receptor blockers. Lightheadedness 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 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.)

ACE inhibitors rather than ARBs continue to be the medication of choice for coronary artery disease, heart failure, and diabetic nephropathy caused by type 1 diabetes. ARBs are a relatively new class of medications. 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.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. American Diabetes Association (2003). Treatment of hypertension in adults with diabetes. Diabetes Care, 26(Suppl 1): S80–S82.

2. Cohn JN, et al. (2001). A randomized trial of the angiotensin receptor blocker valsartan in chronic heart failure. New England Journal of Medicine, 345(23): 1667–1675.

3. American Diabetes Association (2007). Standards of medical care in diabetes. Clinical Practice Recommendations 2007. Diabetes Care, 30(Suppl 1): S4–S41.

Author:	Robin Parks, MS	Last Updated: September 1, 2006
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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