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What are angiotensin receptor blockers, and how do they work?
Angiotensin II is a very potent chemical formed in the blood that causes muscles surrounding blood vessels to contract, thereby narrowing the vessels. This narrowing increases the pressure within the vessels and can cause high blood pressure (hypertension). Angiotensin II receptor blockers (ARBs) are medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. As a result, blood vessels enlarge (dilate) and blood pressure is reduced. Reduced blood pressure makes it easier for the heart to pump blood and can improve heart failure. In addition, the progression of kidney disease caused by the high blood pressure or diabetes is slowed. ARBs have effects that are similar to angiotensin converting enzyme (ACE) inhibitors, but ACE inhibitors act by preventing the formation of angiotensin II rather than by blocking the binding of angiotensin II to muscles on blood vessels.
For what conditions are ARBs used?
- ARBs are used for controlling high blood pressure, treating heart failure, and preventing kidney failure in people with diabetes or high blood pressure.
- ARGs also may prevent diabetes and reduce the risk of stroke in patients with high blood pressure and an enlarged heart.
- ARBs also may prevent the recurrence of atrial fibrillation.
Since ARB medications have effects that are similar to those of ACE inhibitors, they often are used when ACE inhibitors are not tolerated by patients (for example, due to excessive coughing).
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What are the available ARBs?
The following is a list of currently available ARBs:
Are there any differences among the different types of ARBs?
ARBs are similar in actions and side effects. They differ in how they are eliminated from the body and the extent to which they are distributed throughout the body.
What are the side effects of ARBs?
ARBs are well tolerated by most individuals. The most common side effects are
- elevated potassium levels in the blood (hyperkalemia),
- low blood pressure,
- abnormal taste sensation (metallic or salty taste),
- orthostatic hypotension (low blood pressure upon standing),
- indigestion, and
- upper respiratory tract infection.
Compared to ACE inhibitors, cough occurs less often with ARBs.
Serious side effects of ARBs
- The most serious, but rare, side effects are
- There have been reports of rhabdomyolysis (destruction of skeletal muscle) in patients receiving ARBs.
- Individuals who have narrowing of both arteries that supply the kidneys or have had a severe reaction to ARBs should avoid them.
- Like other antihypertensives, ARBs have been associated with sexual dysfunction.
What about taking ARBs during pregnancy?
ARBs usually are not prescribed for women during pregnancy because they may cause birth defects.
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With which drugs do ARBs interact?
- ARBs have few interactions with other drugs.
- Since ARBs may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase potassium may result in excessive blood potassium levels and cardiac arrhythmias.
- ARBs may also increase the blood concentration of lithium (Eskalith, Lithobid) and lead to an increase in side effects from lithium.
- Rifampin (Rifadin) reduces the blood levels of losartan, and fluconazole (Diflucan) reduces the conversion of losartan to its active form. These effects could decrease the effects of losartan.
- ARBs should not be combined with ACE inhibitors because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment.
- ARBs should not be combined with aliskiren (Tekturna) because such combinations increase the risk of kidney failure, excessive low blood pressure, and hyperkalemia.
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Angina SymptomsAngina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm which involves irregular and often rapid beating of the heart. Symptoms may include:
- Shortness of breath
- Chest pain
Treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
Blood Pressure PictureThe blood pressure is the pressure of the blood within the arteries. See a picture of Blood Pressure and learn more about the health topic.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as
- allergic rhinitis,
- sinus infection,
- cigarette smoking,
- postnasal drip,
- medications, and
- less frequently tumors or other lung disease. Treatment of chronic cough is dependent upon the cause.
Chronic cough treatment is based on the cause, but may be soothed natural and home remedies.
Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Diabetes MellitusDiabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Healthy Food on the RunLosing weight is tough on the road. Fast food can't compare to the health of a well-planned, balanced diet. But if you must eat fast food, there are ways to improve the quality of your diet.
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High Blood Pressure HypertensionHigh blood pressure is defined as a pressure of 140/90 mmHg or higher in the arteries. Genetic factors, high salt intake, and increased arterial stiffness cause high blood pressure. Dizziness, headache, nausea, and shortness of breath are just a few symptoms of high blood pressure. Untreated high blood pressure increases the risk of heart disease, kidney disease, atherosclerosis, eye damage, stroke, and increased risk of aneurysms. High blood pressure can be managed with weight loss, lifestyle changes, and medication.
Take the HBP QuizTake this quiz and test your IQ of high blood pressure (hypertension), the cardiovascular disease that causes most strokes and heart attacks. How are dizziness, snoring, and gout related to HBP? Find the answer and learn how medical treatments and lifestyle adjustments fight this common problem.
Kidney FailureKidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, or medication. Some of the renal causes of kidney failure are:
- multiple myeloma, and
- acute glomerulonephritis.
- bladder obstruction,
- prostate problems,
- tumors, or
- kidney stones.
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ParathyroidectomyParathyroidectomy is the removal of one or more of the parathyroid glands to treat hyperparathyroidism. Risks of parathyroidectomy include:
- paralysis of the vocal cords,
- difficulty swallowing thin liquids,
- difficulty breathing,
- and drug reactions.
- damage to the recurrent laryngeal nerve,
- bleeding or hematoma,
- problems maintaining calcium levels in the blood,
- need for further and more aggressive surgery,
- need for a limited or total thyroidectomy,
- prolonged pain,
- impaired healing,
- and recurrence of the tumor.
Renal Artery StenosisRenal artery stenosis is a narrowing of the diameter of the renal arteries. When the renal arteries narrow, the result is restricted blood flow to the kidneys, which may lead to impaired kidney function and high blood pressure (referred to as renovascular hypertension (RVHT). Renal artery stenosis can occur in one or both kidneys. The primary cause of renal artery stenosis is atherosclerosis. Risk factors for renal artery stenosis include:
- high blood pressure,
- high cholesterol levels,
- cigarette smoking,
- and diabetes.
Stroke Symptoms and Treatment
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic). Symptoms of a stroke may include
- double vision or vision loss,
- vertigo, and
- difficulty speaking or understanding speech.
A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.
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