angiotensin II receptor blockers (ARBs)

see also:

• ACE inhibitors
• antihypertensives
• hypertension
• angiotensin receptor–neprilysin inhibitors (ARNIs)

• ARBs were developed to address the issue that some patients taking ACE inhibitors developed bradykinin-mediated angioedema or cough
• ACE inhibitors act by blocking the formation of angiotensin II whereas ARBs act by blocking the actions of angiotensin II
• as with ACE inhibitors, they are primarily used for:
  • hypertension
  • congestive cardiac failure
  • preventing renal disease in diabetics
• they may also reduce risk of stroke in those with cardiomegaly, and may reduce risk of recurrence of atrial fibrillation

• low BP, postural dizziness and postural hypotension
• hyperkalaemia risk
• sinusitis, URTIs, viral illness susceptibility may be an issue
  • ARBs increase ACE2 receptor numbers by 3-5x and some viruses (eg. COVID-19 coronavirus (2019-nCoV / SARS-CoV-2)) use these receptors to gain access to cells
• most tolerate these meds well otherwise, however some develop metallic taste, indigestion, headache, fatigue, drowsiness, sexual dysfunction or diarrhoea
• serious but rare adverse effects:
  • acute kidney injury (AKI) / acute renal failure (ARF) - especially if concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) whilst dehydrated as renal blood flow is impaired or in those with renal artery stenosis
  • hepatitis
  • HS reactions
  • neutropenia
  • thrombocytopenia
  • rhabdomyolysis