Angiotensin receptor blockers contraindications

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

The (3-blockers reduce blood pressure primarily by decreasing cardiac output (Figure 19.7). They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. The prototype (3-blocker is propranolol, which acts at both (3i and (32 receptors. Newer agents, such as atenolol and meto-prolol, are selective for [3-i receptors. These agents are commonly used in disease states such as asthma, in which propanolol is contraindicated due to its (32-mediated bronchoconstriction. (See p. 73 for a complete discussion of (3-blockers.)... 

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