ARBs are typically used to treat high blood pressure, heart failure, and chronic kidney disease. Learn how they work, their benefits, and their side effects. Show
Angiotensin II receptor blockers (ARBs) are typically used to treat high blood pressure, heart failure, and chronic kidney disease (CKD). They may also be prescribed following a heart attack. Your doctor may suggest treatment with ARBs instead of angiotensin-converting enzyme (ACE) inhibitors, another group of hypertension medications. According to the Centers for Disease Control and Prevention (CDC), high blood pressure affects 1 in 3 American adults. Only 54 percent of people with the condition have it under control. If your blood pressure is high all the time, it can damage your heart and lead to other health problems. ARBs may help you to control your blood pressure. Blood vessels supply blood and oxygen to the heart. This constant supply helps the heart function. Angiotensin II is a hormone made by our body, and it tightens the muscles of our blood vessels. Angiotensin II also contributes to salt and water retention in our bodies. Increased salt in the body and tightened blood vessels may cause our blood pressure to rise. High blood pressure harms blood vessels. Both ARBs and ACE inhibitors act on angiotensin II. But while ACE inhibitors limit the formation of angiotensin II, ARBs block certain receptors of angiotensin II. These receptors, known as AT1 receptors, are found in the heart, blood vessels, and kidneys. When blood vessels tighten, they become narrow. This puts blood under greater pressure as it’s forced to move through a smaller-than-normal space. When ARBs block angiotensin II, this reduces the tightening of blood vessels. Blood pressure is then lowered. You may be prescribed ARBs if you have:
Most people take ARBs in once-daily doses in the morning. However, your doctor may also prescribe a twice-daily dose. ARBs don’t have to be taken in the morning. Some people may experience a chronic cough when they take ACE inhibitors, but ARBs don’t usually have this side effect. This is one of the reasons ARBs are often used instead of ACE inhibitors. ARBs can decrease your risk of heart attack, stroke, or death from a cardiac event. If you have kidney disease, ARBs may be one of the more effective treatments for high blood pressure. Some animal and human studies have also shown that ARBs may help protect against cognitive decline. Most doctors will ask you to try an ACE inhibitor first. If it isn’t suitable for you, they may recommend an ARB. Your doctor will likely prescribe either an ACE inhibitor or an ARB but not both at the same time. In July 2010, a meta-analysis of several clinical trials showed an increased cancer risk in people taking ARBs. In June 2011, further research by the FDA indicated no increased risk of developing cancer while taking an ARB. The earlier report included data from five clinical trials, while the FDA’s analysis included more than 30 studies. More recently, studies published in 2014 and 2016 also suggest that there’s no increased risk of cancer in people taking ARBs. A study published in 2017 indicated that ARBs may actually be helpful for people with prostate cancer. At this time, the FDA states that treatment with an ARB medication doesn’t increase the risk of cancer. There’s some evidence that people on ACE inhibitors are less prone to myocardial infarction (MI) and fatal heart and cardiovascular events than people who take ARBs. However, a report from a 2013 meta-analysis showed that ARBs are a good option for reducing the risk of cardiovascular deaths, MI, and stroke in people without heart failure. Valsartan and telmisartan have been found effective in reducing the risk of fatal MI and cardiovascular events. Bear in mind that your body may respond differently than other people’s to any medication. If you have side effects from your medication, tell your doctor immediately. Talk with them, weigh your options, and then decide on the best treatment plan for you. OverviewWhat are ACE inhibitors?Angiotensin-converting enzyme inhibitors, often shortened to ACE inhibitors or ACE-I, are a class of medications that help lower your blood pressure and can protect your kidneys. They’re used to treat cardiovascular (heart- or circulatory system-related) conditions like high blood pressure, heart failure, diabetes-related kidney disease and more. How do they work?ACE inhibitors work just like the name suggests, blocking angiotensin-converting enzyme (ACE) from converting angiotensin I into angiotensin II. Because angiotensin II raises blood pressure in multiple ways, reducing the amount in the body is an effective way to lower blood pressure. Why is blocking ACE so effective?ACE is part of your body’s blood pressure control process. Enzymes like ACE are useful because they are catalysts. That means they make it easier for certain chemical reactions to happen. ACE raises your blood pressure in two ways: Angiotensin I conversionAngiotensin (an-gee-oh-ten-sin) is a hormone found in your body in four different forms (the names of the forms use Roman numerals). ACE turns angiotensin I into angiotensin II, which has multiple effects throughout your body. Some of those effects — all of which increase your blood pressure — include:
Bradykinin breakdownBradykinin (bray-dee-ky-nin) is a protein that lowers your blood pressure by relaxing your blood vessels and helping your kidneys remove sodium from your body. ACE breaks bradykinin down. Less available bradykinin makes your blood pressure go up. Blocking ACE means there’s less angiotensin II to raise your blood pressure, and there’s more bradykinin to lower your blood pressure. What conditions are treated by this class of medication?ACE inhibitors can treat the following conditions:
ACE inhibitors also treat several kidney diseases in people who don’t have diabetes, including:
Are ACE inhibitors commonly prescribed?ACE inhibitors are very commonly prescribed, especially for blood pressure and other cardiovascular conditions. In 2019, about 12.9 million people with Medicare Part D coverage — about 27% of all Medicare Part D beneficiaries — were prescribed an ACE inhibitor. How many ACE inhibitors are there?There are 10 different ACE inhibitors (as of Aug. 2021) approved by the FDA. They are:
All of the ACE inhibitors are taken orally (by mouth). One, enalapril, can also be given in intravenous (IV) form, meaning it can be delivered right to your bloodstream. Risks / BenefitsWhat are the advantages of ACE inhibitors?ACE inhibitors have several advantages that make them first-line medications for treating high blood pressure and other cardiovascular conditions. Those include:
What are the possible side effects and complication risks of these medications?ACE inhibitors do have certain side effects. The majority of these are minor, but some are serious and need immediate medical care. Your healthcare provider can best explain the possible side effects, especially those you should watch for because they are dangerous or severe. In general, the most common side effects for almost all ACE inhibitors include:
Less-common side effects include:
Severe side effectsCertain severe side effects can happen with all ACE inhibitors. These include:
What are the reasons I should not take these medications?There are several reasons why you shouldn’t take ACE inhibitors (these are “contraindications”). You should also ask your healthcare provider if you have any questions about reasons you should or shouldn’t take a medication. They are best prepared to explain any reasons why you shouldn’t take an ACE inhibitor, because they can listen to and answer your questions, review your medical record and look for any potential causes for concern. Some general reasons include the following:
Do ACE inhibitors interact with any other medications?Because ACE inhibitors affect your circulatory system, they can interact with many medications. Your healthcare provider or a pharmacist are the best sources of information when it comes to explaining potential medication interactions. A few possible serious interactions include: Non-steroidal anti-inflammatory drugs (NSAIDs)These over-the-counter pain and inflammation relief medications can sometimes interact with ACE inhibitors and make them less effective or cause a decrease in kidney function. Talk to your healthcare provider before you take any NSAID if you are already taking an ACE inhibitor. NSAIDs come in both prescription and over-the-counter forms. Over-the-counter NSAIDs include:
NSAIDs are very commonly combined with other medications like acetaminophen (the main ingredient in Tylenol®, sometimes called paracetamol internationally), which isn’t an NSAID on its own. You may want to read the label and ask a pharmacist for guidance to make sure any over-the-counter medication you want to take doesn't contain an NSAID without your knowing. Medications that affect your potassium or sodium levelsACE inhibitors affect how your body retains (or doesn’t retain) sodium and potassium. That means other medications that also affect those levels can cause you to have too much of those. Hyperkalemia (too much potassium in the blood), in particular, is a concern with ACE inhibitors. Angiotensin-receptor blockersWhere ACE inhibitors stop angiotensin’s conversion into a usable form, angiotensin-receptor blockers (ARBs) keep your body from using most of its angiotensin II. When used together, they can sometimes affect your kidney function, lower blood pressure and cause dangerous hyperkalemia. Medications that affect your kidneysAn example of this is a medication called aliskiren, which inhibits an enzyme called renin. Renin is also an important part of your body’s control over blood pressure. Are there things I shouldn’t eat or drink while taking an ACE inhibitor?In general, follow your healthcare provider’s guidance when it comes to what you should or shouldn’t eat or drink. This is especially true if your provider tells you to follow a low-sodium diet. Not following that guidance could affect your sodium levels. You also should avoid salt substitutes that contain potassium until you talk to your provider about whether or not those substitutes are safe. While it isn't dangerous, capsaicin — the chemical compound that makes foods like peppers spicy — can sometimes worsen an ACE inhibitor-related cough. Recovery and OutlookHow long can I stay on ACE inhibitors?ACE inhibitors are typically safe for long-term use. In many cases, you can take them indefinitely and for the rest of your life. Can I ever stop taking these medications?You should talk to your healthcare provider before you stop taking these medications. Stopping them suddenly can cause serious and life-threatening medical events, especially ones like heart attack, stroke or worsening heart failure. Depending on why you take an ACE inhibitor, it may be possible to improve your blood pressure to the point where it’s no longer needed. Your doctor can help taper off your dose until it’s safe to stop taking it. In cases where you still have the original health condition but want to stop taking an ACE inhibitor, your healthcare provider can usually help you. They can offer medication alternatives and assist you in switching to another drug that can also help you. If you miss a doseIf you miss a dose of your ACE inhibitor — unless it is closer to the time for your next dose than the one you missed — you should take the dose as soon as possible. If it’s been too long, wait and take only the next dose. Don't take more than your prescribed dose to "catch up" because this can cause severe, dangerous lowering of blood pressure. When to Call the DoctorWhen should I call my healthcare provider?Your healthcare provider is the best person to advise you on when to call them or seek medical attention. In general, you should seek immediate medical attention if you experience any of the following:
A note from Cleveland Clinic ACE inhibitors are an important tool when it comes to treating a wide range of health problems. Depending on what you need and your circumstances, they may be able to help improve your health now and prevent problems in the future. If you have questions about these medications, your primary care provider is a great source of information and guidance. They can offer you options and then help you as you work to manage your health and well-being. Which drug does the nurse know works to lower blood pressure by blocking angiotensin 2 receptor sites?Examples of angiotensin II receptor blockers include: Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan.
What drugs are angiotensin II receptor blockers?Angiotensin receptor blockers (ARBs), also known as angiotensin II receptor antagonists, are used to treat high blood pressure and heart failure. They are also used for chronic kidney disease and prescribed following a heart attack. They include irbesartan, valsartan, losartan and candesartan.
What is the best angiotensin II receptor blocker?With an aim to prevent CV events, primarily telmisartan and eventually losartan are the ARBs of choice in patients with high CV risk and a general need for CV risk reduction. In the case of HF patients, losartan, candesartan or valsartan should be chosen.
Is losartan an angiotensin II receptor blocker?Valsartan, losartan, irbesartan and other “-sartan” drugs are a class of medicines known as angiotensin II receptor blocker (ARBs) used to treat high blood pressure and heart failure.
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Which drug does the nurse know works to lower blood pressure by blocking angiotensin II receptor sites?
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