Angiotensin II receptor blockers ARBs

If a patient is diabetic, ACE-I will be advised, because it may reduce new-onset of HE and protect against nephropathy. The use of an Angiotensin-II receptor blocker (ARB) is also a good choice for these diabetic patients and for their nephropathy. The basic concept of drug selection will be combination therapy using different classes such as ACE-I and... 

Patients with diabetes are at very high riskfor cardiovascular disease. All patients with diabetes and hypertension should be managed with either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), typically in combination with one or more other antihypertensive agents. Multiple agents frequently are needed to control BP. 

Three landmark placebo-controlled clinical trials have established the benefits of both hypertension treatment and diuretic therapy. The Systolic Hypertension in the Elderly Program (SHEP), the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension), and the Medical Research Council (MRC) trial " showed significant reductions in stroke, myocardial infarction, and aU-cause cardiovascular disease and mortality with thiazide diuretic-based therapy versus placebo. These trials allowed for /3-blockers as add-on therapy for BP control. Newer agents (i.e., ACE inhibitors, angiotensin II receptor blockers [ARBs], and calcium channel blockers [CCBs]) were not available at the time of these studies. However, subsequent clinical trials have compared these newer antihypertensive agents (ACE inhibitors, ARBs, and CCBs) to diuretics." These data show similar effects, but most trials used a prospective, open-label, blinded end point (PROBE) study methodology that is... 

The incidence of ACEI- or angiotensin II receptor blocker (ARB)-mediated renal failure has not been established. However, patients with severe atherosclerotic renal artery stenosis, those hospitalized with congestive heart failure, and those with chronic kidney disease, including diabetic nephropathy, are most likely to experience a significant decline in renal function with these agents. 

ACEIs and angiotensin II receptor blockers (ARBs) traditionally have been avoided in kidney transplant recipients because of the potential for hyperkalemia and decreased glomerular filtration rate. ACEIs and ARBs are now considered to be an equivalent alternative to calcium channel blockers for the treatment of hypertension in aU transplant recipients. When ACEIs or ARBs are used in patients after transplantation, serum creatinine and potassium levels should be mon-... 

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