CV Angiotensin receptor blockers

Question 1

When are Angiotensin Receptor blockers used?

Answer 1

When ACE inhibitors not tolerated due to cough

Question 2

What are examples of ARBs?

Answer 2

1. Losartan
2. Candesartan
3. Irbesartan

Question 3

What are the indications for ARBs?

Answer 3

1st/2nd line treatment of Hypertension,reduce risk of stroke, myocardial infarction, death from cardiac disease

Question 4

What are the indications for ARBs?

Answer 4

Chronic heart failure:1st line treatment, to improve symptoms and prognosis

Question 5

What are the indications for ARBs?

Answer 5

Ischaemic heart disease: to reduce the risk of subsequent cardiovascular events suchas myocardial infarction and stroke

Question 6

What are the indiactions of ARBs

Answer 6

Diabetic neuropathy and chronic kidney disease

Question 7

What is the mechanism of action for ARBs?

Answer 7

1. Blocks action of angiotensin II on the AT1 receptor
2. Angio II is a vasoconstrictor and stimulates aldosterone
3. Blocking its action reduces peripheral vascular resistance, lowering BP
4. Reducing aldosterone promotes Na and H2O secretion

Question 8

What are the major adverse affects of ARBs?

Answer 8

1. Hypotension
2. Hyperkalaemia
3. Headaches and dizziness
4. Less likely to cause angioedema

Question 9

Warnings?

Answer 9

1. Renal artery stenosis
2. Acute kidney injury
3. Pregnancy
4. Breastfeeding
5. CKD

Question 10

How are ARbs Px?

Answer 10

1. Common choice is losartan 12.5mg daily in HF

Question 11

Clinical Tip?

Answer 11

The incidence of angioedema related to ACE inhibitor treatment is five times higher (about 1%) in black people of African or Caribbean origin. The exact mechanism by which ACE inhibitors lead to angioedema is not completely understood but is thought to relate to altered bradykinin metabolism. ARBs do not affect levels of bradykinin and are less likely to cause angioedema. They therefore may be preferable to ACE inhibitors in this group.