Category:Angiotensin receptor blocker

From Ganfyd

Introduction

This class of drugs block the angiotensin ii receptor in the renin-angiotensin system and have many properties in common with ACE inhibitors. However, unlike ACE inhibitors, they do not inhibit the breakdown of bradykinin and other kinins, and thus do not appear to cause the persistent dry cough which commonly complicates ACE inhibitor therapy. They are therefore a useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough. They are second choice to ACE inhibitors both because of cost and more overall side-effects^[1].

History

See ACE inhibitors. The octapeptide angiotensin II receptor blocker saralasin was actually demonstrated to work in man in the mid 1970s, with publications from 1975, before the first ACE inhibitor work in man. This is still a very active area of research, both public and undisclosed for commercial reasons. There appear to be several receptors for angiotension II and the area of research even extends into a possible role for some angiotension II blockers as antibiotics^[2]. Accordingly they are not quite the same as ACE inhibitors and may have unique beneficial properties as in preventing dementia^[3].

Clinical Differences

These do appear to exist, with for example the evidence for use in non specific heart failure being strongest for candesartan, diabetic renal failure strongest for irbesartan^[4] and gout strongest for losartan^[5].

Indications

Group Side effects

Angioneurotic oedema whch is a recognised occasional adverse reaction to ACE blockers has also been reported with ARBs. It is less than certain how likely exhibiting an ARB in a patient who had to cease their ACE is to cause the same trouble. An estimate is that the risk is 1 in 3.

Group Interactions

Special advice

References