SARTANs aka angiotensin receptor agonists (ARA) Flashcards
SARTANs a.k.a. …
angiotensin receptor agonists (ARA)
MOA
sartans / ARA
Competitively block binding of angiotensin II to type 1 angiotensin (AT1) receptors. They reduce angiotensin II-induced vasoconstriction, sodium reabsorption and aldosterone release. They also reduce the effect of angiotensin II on sympathetic nervous activity and growth factors.
Indication
sartans / ARAs
- Hypertension
- Chronic heart failure with reduced ejection fraction as part of standard treatment in patients unable to tolerate ACE inhibitors
Adverse effects
sartans
dizziness, headache, hyperkalaemia
Precautions / contradictions
sartans / ARAs
Peripheral vascular disease or atherosclerosis—patients may be more likely to have renal artery stenosis.
Volume or sodium depletion—Monitor combination w/ diuretics (both affect sodium and BP)
Black African or Caribbean descent
Treatment with drugs that can increase potassium concentration,
Practice points
sartans / ARAs
- stop K+ and K+ sparing diuretics
- review use of NSAIDs
- check renal function
- used when ACE inhibitors are not tolerated for HTN and chronic heart failure
You may feel dizzy when you start taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy or light-headed.
Do not take potassium supplements while you are taking this medicine unless your doctor tells you to.
when starting a sartan:
stop potassium supplements and potassium-sparing diuretics
in heart failure, consider reducing dose or withholding other diuretics for 24 hours before starting a sartan
review use of NSAIDs (including selective COX‑2 inhibitors)
start with a low dose
check renal function and electrolytes before starting a sartan and review after 1–2 weeks
unlike ACE inhibitors, sartans do not inhibit the breakdown of bradykinin and may be useful if an ACE inhibitor is not tolerated because they:
cause less cough than ACE inhibitors
may be used if there is a history of angioedema caused by an ACE inhibitor (with close monitoring as there is a small risk of recurrence)
maximum antihypertensive effect occurs about 4–6 weeks after starting treatment
encourage patients to continue sartans during the COVID‑19 pandemic as there is no clinical evidence to support stopping treatment
Drug class and indication
Candesartan
sartan / ARA
* Hypertension
* Chronic heart failure with reduced ejection fraction as part of standard treatment in patients unable to tolerate ACE inhibitors
Drug class and indication
Candesartan with hydrochlorothiazide
sartan / ARA + thiazide diuretic
Hypertension
Drug class and indication
Eprosartan
sartan / ARA
Hypertension
Drug class and indication
Eprosartan with hydrochlorothiazide
sartan / ARA + thiazide diuretic
Hypertension
Drug class and indication
Irbesartan
sartan / ARA
* Hypertension
* Reduction of renal disease progression in patients with type 2 diabetes, hypertension and microalbuminuria (>30 mg/24 hours) or proteinuria (>900 mg/24 hours)
Drug class and indication
Irbesartan with hydrochlorothiazide
sartan /ARA + thiazide diuretic
Hypertension
Drug class and indication
Losartan
sartan / ARA
* Hypertension
* Reduction of renal disease progression in patients with type 2 diabetes, hypertension and proteinuria (urinary albumin to creatinine ratio greater than or equal to 300 mg/g or proteinuria >500 mg per 24 hours)
Drug class and indication
Olmesartan
sartan / ARA
Hypertension
Drug class and indication
Olmesartan with amlodipine
sartan / ARA + Dihydropyridine calcium channel blocker
Hypertension
