Angiotensin receptor blockers ARBs

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... 

ACE inhibitors and angiotensin-receptor blockers (ARB) have definite benefits in patients with nephropathy and are believed to have renoprotective effects in most patients. Due to their ability to cause an initial bump in serum creatinine, these agents should be used cautiously when employed in combination with the calcineurin inhibitors. The dihydropyridine calcium channel blockers have demonstrated an ability to reverse the nephrotoxicity associated with cyclosporine and tacrolimus (Table 52-8). In general, antihypertensive therapy should focus on agents with proven benefit in reducing the progression of cardiovascular disease and should be chosen on a patient-specific basis.55 See Chapter 2 for further recommendations for treating HTN. 

Angiotensin receptor blockers (ARBs) Antagonize All effects at ATj receptors Like ACE inhibitors Like ACE inhibitors used in patients intolerant to ACE inhibitors Oral duration 6-8 h Toxicity Hyperkalemia angioneurotic edema Interactions Additive with other angiotensin antagonists... 

At Cynthia s pharmacy, patients with heart disease are usually on several medications for their heart disease a diuretic, a beta blocker, and an angiotensin-converting enzyme (ACE) inhibitor. Patients with more severe disease may also be on an aldosterone inhibitor such as spironolactone, digoxin, hydralazine nitrate, and/or an angiotensin-receptor blocker (ARB). Some patients are... 

The efficacy of aliskiren monotherapy and aliskiren in combination with the diuretic hydrochlorothiazide (HCT), aliskiren in combination with the angiotensin receptor blocker (ARB) valsartan, and aliskiren in combination with the ACE inhibitor ramipril in reducing mean sitting diastolic blood pressure (msDBP) have been reported (Table 3). From a pooled analysis of several placebo-controlled clinical trials, the approved doses of 150 and 300 mg aliskiren provide a placebo-subtracted reduction in msDBP of 3.2 and... 

What is the primary pharmacology of angiotensin receptor blockers (ARBs) ... 

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. ... 

Triazoles and tetrazoles do not exist in nature. However, many synthetic medicines do contain triazoles and tetrazoles. For instance, valsartan, an angiotensin receptor blocker (ARB) indicated for heatment of high blood pressure and other cardiovascular disease contains a tetrazole. Anastrozole contains a 1,2,4-triazole and is an aromatase-inhibiting drug approved for treatment of breast cancer. Tazobactam is a 1,2,3-triazole containing compound that inhibits the action of bacterial -lactamases and is used to treat bacterial infection in combination with the beta-lactam antibiotic piperacillin. ... 

Several standard drug therapies can markedly improve survival from cardiovascular disease in select patient populations. These include j8-blockers (77-79), aspirin (80,81), angiotensin converting enzyme (ACE) inhibitors (82,83), angiotensin receptor blockers (ARBs) (84-86), anticoagulants (including warfarin and aspirin) (87-90), aldosterone antagonists (91), and HMG-CoA reductase inhibitors (78-80,83,86,92-98). 

Clinicaltrials.gov. Study of Preoperative Management of Angiotensin Converting Enzyme Inhibitor (ACEi) and Angiotensin Receptor Blocker (ARB) Medications (PASS), Qntario, Canada 2010. ... 

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