Angiotensin receptor blockers (ARB's for short) are primarily used to treat high blood pressure, although there is a growing body of evidence that these drugs are useful in the treatment of other cardiac diseases such as stroke, heart attack and congestive heart failure (CHF).
Angiotensin receptor blockers also seem to have a beneficial effect on the kidney, particularly the kidneys of people with diabetes.
These days, it seems that angiotensin receptor blockers can do everything ACE inhibitors can do. However, unlike ACE inhibitors, ARB usage is not associated with cough.
All angiotensin receptor blockers come with a pregnancy Black Box. The Black Box warns that if you take an ARB during the second or third trimester of your pregnancy, the fetus can be severely harmed.
For this reason it is a good idea for a woman of child-bearing age to have a negative pregnancy test before she begins therapy.
Also similar to ACE inhibitors, you have to be very careful to monitor the patient's potassium levels when combining ARB's with other drugs such as diuretics and potassium supplements.
Similar to ACE inhibitors, angioedema may occur as a side effect during Angiotensin receptor blocker therapy, although it is rare. The angioedema could involve the mouth, throat, tongue, lips and eyelids or it can be generalized in nature.
Patients being started on ARB therapy should be advised to contact their physician at once if they experience any usual, acute-onset swelling of soft tissues of the mouth and throat, eyelids, lips etcetera because angioedema can be life threatening.
We are not sure of the exact mechanism by which ARB's cause angioedema. Unlike ACE inhibitors, ARB's do not inhibit the degradation of bradykinin. More research is needed in this area.
How do Angiotensin receptor blockers work?
To understand how angiotensin receptor blockers work, you need to know about angiotensin. Angiotensin is a chemical that your body creates that is needed to regulate blood pressure.
If your blood pressure suddenly became too low, you could get a stroke. Also, adequate blood pressure is necessary for the kidneys to do their job of filtering out the blood of waste products and toxic compounds.
Angiotensin is used by the human body as a blood pressure elevator. Angiotensin acts as a powerful vasoconstrictor (it causes your blood vessels to tighten up thereby reducing their inner diameter).
When your body needs to ratchet up blood pressure, (such as during periods of exercise or stress) your body releases a tiny amount of angiotensin.
Think of it this way: let's say you are watering your garden with a garden hose. What would happen if all of a sudden, the hose's diameter shrunk down to the width of a drinking straw? The pressure would increase!
Angiotensin receptor blockers form a protective shield on the blood vessels so that angiotensin's ability to tighten up your blood vessels is reduced. If the angiotensin can't do it's job the blood vessels remain in a relaxed state and blood pressure remains low.
How can you make angiotensin receptor blocking agents stronger? Combination with diuretics
In and of themselves, ARB's are not terribly potent. However, when you add a water-pill into the mix, the blood-pressure lowing effect of the ARB is greatly enhanced.
For this reason, all of the ARB's are available as a combination pill that contains the ARB plus a small dose of water pill (usually hydrochlorthiazide).
It should also be noted that in patients with severe renal impairment (creatinine clearance below 30mL/minute) loop diuretics are preferred to thiazides.
The drug companies warn the doctors not use a combination ARB/water pill to initiate therapy. Sometimes doctors do this anyway if they feel that a patient's blood pressure needs to be managed rapidly and the benefits outweigh the risks.
Atacand (Candesartan; Astra Zeneca)
Atacand + Hydrochlorthiazide = Atacand HCT
Atacand is available in four strengths - 4mg, 8mg, 16mg, and 32mg.
Atacand HCT is available 16mg/12.5mg (16 mg of Atacand + 12.5mg of hydrochlorthiazide) and 32mg/12.5mg (32mg of Atacand + 12.5mg of hydrochlorthiazide) combination pills.
Depending on the strength of the pill, Atacand goes for $2.00 - $3.00per pill. Because Atacand is an expensive and popular drug, some internet pharmacies discount it to get you in the door: Click Here To Comparison Shop for Atacand and Atacand HCT.
Atacand.com - Official website; Prescribing Information
Atacand HCT - prescribing information ( pdf file)
Atacand Patient Info
Avapro (Irbesartan; Sanofi-Aventis)
Avapro + Hydrochlorthiazide = Avalide
Comparison Shop For Avapro and Avalide
Avapro.com - official website;
Avapro Price Data
Avalide Price Data
BENICAR (Olmesartan; Sankyo, Forest)
Benicar + Hydrochlorthiazide = Benicar HCT
Comparison Shop For Benicar and Benicar HCT
Benicar tablets are available in three strengths : 5mg, 20mg and 40mg. The combination pill (Benicar + Hydrochlorthiazide) is also available in 3 strengths: 20/12.5, 40/12.5, 40/25.
Benicar was the newest ARB on the market quickly became popular. Benicar was invented in Japan. Click here to Comparison Shop For Benicar and Benicar HCT.
Benicar.com - Prescribing Information
Cozaar (Losartan; Merck)
Cozaar + Hydrochlorthiazide = Hyzaar
Cozaar was the first ARB on the market. Cozaar was invented by the scientists of Merck & Company. When Cozaar first came out, it had no competitors. With each new ARB that is introduced into the marketplace, Cozaar becomes less and less popular. The Cozaar pill has an unusual shape that makes it hard to split the pill. Click Here to Comparison Shop For Cozaar
CozaarAndHyzaar.com - Prescribing Info, Guarantee Program, Links
Cozaar Patient Info | Hyzaar Patient Info
Cozaar Price Data
Hyzaar Price Data
Diovan (Valsartan; Novartis)
Diovan + Hydrochlorthiazide = DIOVAN HCT
Diovan is one of the top selling angiotensin blocking agents. Diovan does more than $3 billion in sales each year.
Diovan is available in 4 strengths - 40mg, 80mg, 160mg and 320mg. The combination pill ( Diovan + hydrochlorthiazide) is available in 3 strengths - 80/12.5, 160/12.5 and 160/25.
If you buy Diovan at the drugstore, Diovan pills should cost around $1.75 - $2.00 per pill. Since it is an expensive and popular drug, some internet pharmacies discount it to get you in the door: Click Here To Comparison Shop for Diovan and Diovan HCT.
Diovan.com - Prescribing Information, MOA, Efficacy Data, Patient Info
Micardis (Telmisartan; Boehringer Ingelheim Also marketed by Abbott)
Micardis + Hydrochlorthiazide = Micardis HCT
Click Here to Comparison Shop For Micardis.
Some doctors believe that Micardis is the strongest ARB. However, this is controversial. Micardis is available in 3 strengths - 20mg, 40mg and 80mg. The combination Micardis/hydrochlorthiazide pill is available in 3 strengths - 40/12.5, 80/12.5, and 80/25. Click Here To Comparison Shop for Micardis and Micardis HCT.
Micardis.com - official website; international
Eprosartan; Solvay (Abbott)
Comparison Shop for Teveten
Teventen is not a popular drug. However, Teventen is inexpensive. If you are taking an expensive ARB such as Cozaar or Diovan, you can save money by switching over to Teventen and save a little money. (You must not do this on your own - you must ask your doctor to help you).
Teveten.com - official website; prescribing information
Prescribing Information - pdf file
Angiotensin receptor antagonists for the treatment of hypertension - explanation of how ARB's work; includes overview of RAA system… (AustralianPrescriber.com)
Merck Manual RAA schematic - visual of how RAA operates.
Medscape RAA schematic - nice visual of RAA system.
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