Angiotensin II Receptor Blockers (ARBs)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

View the High Blood Pressure (Hypertension) Slideshow Pictures

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?

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).

Quick GuideHow to Lower Blood Pressure: Exercise Tips

How to Lower Blood Pressure: Exercise Tips

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.

  • Some ARBs need to be converted to an active form in the body before they can lower blood pressure. In addition, some ARBs are better at lowering blood pressure.
  • In some studies, irbesartan (Avapro) and candesartan (Atacand) reduced blood pressure better than losartan (Cozaar).

What are the side effects of ARBs?

ARBs are well tolerated by most individuals. The most common side effects are

Compared to ACE inhibitors, cough occurs less often with ARBs.

Serious side effects of ARBs

  • The most serious, but rare, side effects are
    • kidney failure,
    • liver failure (hepatitis),
    • serious allergic reactions,
    • a decrease in white blood cells,
    • a decrease in blood platelets, and
    • swelling of tissues (angioedema).
  • 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.

Quick GuideHow to Lower Blood Pressure: Exercise Tips

How to Lower Blood Pressure: Exercise Tips

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.

REFERENCE:

FDA Prescribing Information

Summary

Angiotensin II receptor blockers (ARBs) are a class of drugs prescribed to control blood pressure, treat heart failure, and prevent kidney failure in people with diabetes or high blood pressure. Examples of ARBs include candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan), losartan (Cozaar), and olmesartan (Benicar). Side effects, drug interactions, and patient safety information should be reviewed prior to taking any medication.

Treatment & Diagnosis

Medications & Supplements

Prevention & Wellness

Quick GuideHow to Lower Blood Pressure: Exercise Tips

How to Lower Blood Pressure: Exercise Tips

Subscribe to MedicineNet's Heart Health Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

FDA Logo

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Reviewed on 5/12/2016
References
REFERENCE:

FDA Prescribing Information

Health Solutions From Our Sponsors