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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.
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.
FDA Prescribing Information
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.
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FDA Prescribing Information
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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.
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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.
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High Blood Pressure Hypertension
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
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Kidney 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 include sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis.
Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones.Treatment options included diet, medications, or dialysis.
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- damage to the recurrent laryngeal nerve,
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- problems maintaining calcium levels in the blood,
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- and recurrence of the tumor.
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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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