The drug atlas
Cardiovascular/Angiotensin-II receptor blocker
Angiotensin receptor blockers
also: ARB · -sartan
Overview
Used where an ACE inhibitor is indicated but not tolerated (typically the cough). The "-sartan" drugs.
Mechanism
Selective antagonism of the angiotensin-II type-1 (AT₁) receptor → blocks AngII vasoconstriction + aldosterone release, WITHOUT affecting bradykinin → far less cough.
Indications
- Hypertension
- Heart failure
- Diabetic / proteinuric CKD
- ACEi-intolerant patients (cough)
The agents
LosartanAT₁ blocker
OD/BD
Mild uricosuric.
CandesartanAT₁ blocker
OD
Strong HF evidence.
ValsartanAT₁ blocker
OD
Post-MI, HF.
IrbesartanAT₁ blocker
OD
Diabetic nephropathy.
Adverse effects
Hyperkalaemiaserious
AKIserious
Same renal-haemodynamic mechanism as ACEi.
Hypotension / dizzinesscommon
Coughcommon
Much rarer than ACEi (no bradykinin effect).
Cautions & contraindications
Pregnancypregnancy
Same fetotoxicity as ACEi.
Bilateral renal artery stenosisall
Hyperkalaemiaall
Interactions
- Do NOT combine with an ACEi or aliskiren
- K⁺-sparing agents / NSAIDs as for ACEi
Monitoring & kinetics
U&E/eGFR + K⁺ (as ACEi),BP
Oral. Hepatic + renal handling varies by agent.
Source: BNF — Angiotensin-II receptor antagonists