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Angiotensin II receptor blockers combined with diuretic
Angiotensin II receptor blockers inhibit
a substance that causes blood vessels to narrow (constrict). As a result, blood
vessels relax and widen (dilate), making it easier for blood to flow through
the vessels, which reduces blood pressure. These medicines also increase the
release of water and salt (sodium) to the urine, which in turn lowers blood
pressure as well.
Preventing the blood vessels from constricting
helps improve blood flow, which reduces the backup of blood in the heart and
lungs. It also decreases the pressure that the left ventricle of the heart must
Angiotensin II receptor blockers also act directly
on the hormones that regulate sodium and water balance.
Angiotensin II receptor blockers can
be used to treat
coronary artery disease or heart failure in some
people who cannot tolerate ACE inhibitors or who have kidney disease from
diabetes (diabetic nephropathy) and in people with type 2
An angiotensin II receptor blocker (ARB) may be used
instead of an angiotensin-converting enzyme (ACE) inhibitor if you are not able
to tolerate certain side effects of an ACE inhibitor. ACE inhibitors can cause
an annoying cough. This cough may be hard for some people to live with. So
doctors may prescribe an ARB instead, because ARBs are less likely to cause a
ARBs can lower the risk of death
from heart failure. ARBs also reduce the number of people with heart failure
who need to go into the hospital. ARBs have been shown to work as well as ACE
inhibitors for heart failure.1 ARBs are less likely to cause the cough that is associated with
For advanced heart failure, an ARB may be taken with an ACE
inhibitor to help lower the risk of dying or needing to go into
the hospital.1 But if you take an ARB with an ACE
inhibitor, you have a higher risk for kidney problems and for potassium levels
that are too high.2 For this reason, you will likely need close
If you are taking an ARB because you have diabetes and early signs of kidney problems, or have kidney disease, these medicines can slow or prevent further damage to your kidneys.3
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Call 911 or other emergency services right away if you have:
Call your doctor if you have:
Common side effects of this medicine include:
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
Tell your doctor about all of the other medicines that you take, including prescription and over-the-counter medicines. ARBs may interact with other medicines such as
NSAID pain relievers (nonsteroidal anti-inflammatory drugs),
antacids, potassium supplements, certain diuretics, and lithium. If you are
taking one of these medicines, talk with your doctor before taking an
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
For tips on taking medicine for heart failure, see:
Do not use this medicine if you are pregnant or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.
You will likely have regular blood tests to monitor how the medicine is working in your body and to see if this medicine is causing problems.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
McKelvie R (2011). Heart failure, search date August 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Wolpert C, Borggrefe M (2008). The implantable cardioverter defibrillator. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1109–1120. New York: McGraw-Hill Medical.
Drugs for hypertension (2009). Treatment Guidelines From The Medical Letter, 7(77): 1–10.
April 26, 2012
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Margaret Hetherington, PHM, BsC - Pharmacy
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