Angiotensin antagonists adverse effects

ACE inhibitors prevent the formation of angiotensin II by angiotensin-converting enzyme (ACE) and thereby reduce peripheral vascular resistance and blood pressure. In addition, ACE inhibitors prevent the effect of angiotensin II on protein synthesis in myocardial and vascular muscle cells, and thus diminish ventricular hypertrophy. As adverse effects, ACE inhibitors may provoke dry cough, impaired renal function, and hyperkalemia. When ACE inhibitors are poorly tolerated, an ATq-receptor antagonist can be given. 

The safety profile of angiotensin II receptor antagonists is so far remarkably good. Except for hypotension, virtually no dose-related adverse effects have been reported. Headache, dizziness, weakness, and fatigue are the most common adverse effects. There have been reports of raised liver enzymes (9), cholestatic hepatitis (10), and pancreatitis (11) with losartan. Several cases of angio-edema have been reported but no other obvious hypersensitivity reactions. 

Irbesartan is a potent selective angiotensin II type 1 (ATi) receptor antagonist Its pharmacology is the same as that of other angiotensin II receptor antagonists (1). In the registration studies and other controlled trials adverse effects were not dose-related and not different from placebo. 

May decrease antihypertensive effects of ACE inhibitors and angiotensin II antagonists decrease of antihypertensive and diuretic effects of hydrochlorothiazide and furosemide concomitant use with other NSAIDs may increase Gl adverse effects. 

Angiotensin-II-receptor antagonists (ARBs) are approved for the treatment of hypertension. In addition, irbesartan and losartan are approved for diabetic nephropathy, losar-tan is approved for stroke prophylaxis, and valsartan is approved for heart failure patients who are intolerant of angiotensin-converting enzyme (ACE) inhibitors. The efficacy of ARBs in lowering blood pressure (BP) is comparable with that of other established antihypertensive drugs, with an adverse-effect profile similar to that of placebo. ARBs also are available as fixed-dose combinations with hydrochlorothiazide. 

In addition, due to their effects on aldosterone, the ACE inhibitors and angiotensin II antagonists may increase potassium concentrations and can therefore have additive hyperkalaemic effects with other drugs that cause elevated potassium levels. Furthermore, drugs that affect renal function may potentiate the adverse effects of ACE inhibitors and angiotensin II antagonists on the kidneys. 

Urinary tract Acute renal insufficiency with hyperkalemia has been reported in a 76-year-old hypertensive woman taking both aliskiren and spironolactone [68 ]. Preexisting renal impairment and concomitant use of an aldosterone receptor antagonist were predisposing factors, and it is not surprising that the same pattern of adverse effects is seen in cases like this as have been seen with ACE inhibitors and angiotensin receptor blockers before. 

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