Hypertension angiotensin receptor blockers

Calcium-channel blockers such as amlodipine can be used in patients receiving angiotensin-receptor blockers such as valsartan for the treatment of hypertension and angina. Side-effects common to both drugs include dizziness and hypotension. 

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If the confirmatory test result is positive, treatment witli an ACE inhibitor or angiotensin-receptor blocker should be initiated. ACE inhibitors delay the progression to overt nephropathy, and the National Kidney Foundation recommends their use in both normotensive and hypertensive type 1 and 2 diabetic patients. The role of monitoring UAE in patients on ACE inhibitor therapy is less clear, although many experts recommend continued surveillance. Untreated, the UAE would increase 10% to 30% per year, whereas the albumin creatinine ratio in patients on ACE inhibitors should stabilize or decrease by up to 50%. 

Initial therapy choices for hypertension in diabetes mellitus usually include angiotensin-converting enzyme inhibitors or an angiotensin receptor blocker due to their well documented renoprotective effects. Currently, angiotensin receptor blockers have less robust data to support cardiovascular reduction compared to other therapeutic choices, yet the data that exists appears to be positive in patients with type 2 DM. Also, diuretics have shown superior results to an ACE inhibitor in the ALLHAT trial. The ADA currently recommends the use of any class (ACE inhibitors, angiotensin receptor blockers, /3-blockers, diuretics, or calcium channel blockers) of antihypertensive medication that has shown benefit in prevention of poor cardiovascular outcomes. Choice of monotherapy may not be important, as an average of two to three antihypertensive medications are needed to reach blood pressure goals. 

Savoia, C, Touyz, RM, Endemann, DH, Pu, Q, Ko, EA, De Ciuceis, C, Schiffrin, EL Angiotensin receptor blocker added to previous antihypertensive agents on arteries of diabetic hypertensive patients. Hypertension 48 271-277, 2006. 

Verdecchia P, Angeli F, Mazzotta G, Ambrosio G, Reboldi G. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers in the treatment of hypertension should they be used together Curr Vase Pharmacol 2010 8 (6) 742-6. 

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. 

Flynn IT, Meyers KEC, Neto IP, de Paula Meneses R, Zurowska A, Bagga A, Mattheyse L, Shi V, Gupte J, Solar-Yohay S, Han G. Efficacy and safety of the angiotensin receptor blocker valsartan in children with hypertension aged 1 to 5 years. Hypertension 2008 52 222-8. 

Crook, E.D. and Penumalee, S. 2004. Therapeutic controversies in hypertension management angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers in diabetic nephropathy ACE inhibitors. Ethnicity disease, 14(4), S2-1-4. 

Lee SE, Kim YJ, Lee HY, Yang HM, Park CG, Kim JJ, et al. Efficacy and tolerability of fimasartan, a new angiotensin receptor blocker, compared with losartan (50/100 mg) a 12-week, phase 111, multicenter, prospective, randomized, double-blind, parallel-group, dose escalation clinical trial with an optional 12-week extension phase in adult Korean patients with mild-to-moderate hypertension. Ghn Ther 2012 34 552-68. 

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers decrease protein excretion and are the drugs of choice for hypertension in patients with CKD. 

Medications can increase the risk of hyperkalemia in patients with CKD, including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, used for the treatment of proteinuria and hypertension. Potassium-sparing diuretics, used for the treatment of edema and chronic heart failure, can also exacerbate the development of hyperkalemia, and should be used with caution in patients with stage 3 CKD or higher. 

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