Angiotensin receptor blockers adverse effects

Many patients cannot tolerate chronic ACE inhibitor therapy secondary to adverse effects outlined below. Alternatively, the angiotensin receptor blockers (ARBs), can-desartan and valsartan, have been documented in trials to improve clinical outcomes in patients with heart failure.68,69 Therefore, either an ACE inhibitor or candesartan or valsartan are acceptable choices for chronic therapy for patients who have a low ejection fraction (EF) and heart failure following MI. Since more than five different ACE inhibitors have proven benefits in MI while only two ARBs have been studied, the benefits of ACE inhibitors are generally considered a... 

Besides hypotension, the most frequent adverse reaction to an ACE inhibitor is cough, which may occur in up to 30% of patients. Patients with ACE inhibitor cough and either clinical signs of heart failure or LVEE less than 40% may be prescribed an angiotensin-receptor blocker (ARB). Both candesartan and valsartan have improved outcomes in clinical trials in patients with heart failure. Other less common but more serious adverse effects of ACE inhibitors include acute renal failure, hyperkalemia, and angioedema. Although some data have suggested that aspirin use may decrease the benefits from ACE inhibitor treatment, a systematic review of more than 20,000 patients demonstrated that ACE inhibitors improve outcome irrespective of treatment with aspirin. ... 

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. 

The nanopeptide losartan [LOW sar tan], a highly selective angiotensin II receptor blocker, has recently been approved for antihypertensive therapy. Its pharmacologic effects are similar to ACE inhibitors in that it produces vasodilation and blocks aldosterone secretion. Its adverse effects profile is improved over the ACE inhibitors, although it is fetotoxic. 

Chronic cough is a common adverse effect of ACE inhibitors. It may be relieved by prior administration of aspirin. These drugs are very commonly used in diabetes. Angiotensin II receptor blockers such as losartan and valsartan have a much lower incidence of cough but do cause renal damage in the fetus. The answer is (A). 

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