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.

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 medicines 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 can lower the risk of death from heart failure. ARBs also reduce the number of people with heart failure who need to go into the hospital. ARBs have been shown to work as well as ACE inhibitors for heart failure.¹

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

For advanced heart failure, an ARB may be taken with an ACE inhibitor or beta-blocker to help lower the risk of dying or needing to go into the hospital.¹ 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.

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 medicines, talk with your doctor before taking any other medicines.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

ARBs may increase potassium levels in the blood and may make kidney function worse in people who have diabetes or reduced kidney function. ACE inhibitors also have the same potential complications.

If you are pregnant or could become pregnant, do not take ARBs.

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

Citations

1. McKelvie R (2008). Heart failure, search date January 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

2. American Diabetes Association (2008). Standards of medical care in diabetes. Diabetes Care, 31 (Suppl 1): S12–S54.

Author:	Robin Parks, MS	Last Updated: August 25, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology
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