Pharmaceutical agent review: Focus on Angiotensin II receptor blockers (ARBs)

Angiotensin II Receptor Blockers (ARBs): A Comprehensive Analysis

In the realm of blood pressure management, Angiotensin II Receptor Blockers (ARBs) have emerged as a crucial group of medications. Despite their similarities in treating hypertension, congestive heart failure, and diabetic nephropathy, ARBs differ significantly from another class of drugs called ACE inhibitors in their mechanism of action within the renin-angiotensin system.

ARBs, such as Azilsartan (Edarbi), eprosartan (Teveten), candesartan (Amias), olmesartan (Olmetec), telmisartan (Micardis), valsartan (Diovan), losartan (Cozaar), and irbesartan (Aprovel), work by preventing angiotensin II from connecting to some of its receptors, thereby reducing the effects of this hormone on blood vessels and the heart.

Common side effects of ARBs include dizziness, fatigue, headache, nasal congestion, upper respiratory infections, back pain, and joint or muscle pain. Some patients may also experience high potassium levels (hyperkalemia), diarrhea, cough (less common than with ACE inhibitors), and low blood pressure.

Losartan, for instance, is associated with more common side effects like dizziness, upper respiratory infections, nasal congestion, and back pain, while fatigue and diarrhea occur more in patients with diabetic complications. It may also raise potassium levels and cause hyponatremia (low sodium). Valsartan shares similar side effects such as dizziness, headaches, nausea, vomiting, and low blood pressure, with rare risks to kidney function and blood cell counts.

While these side effects are often mild and temporary, it's crucial to monitor for changes in electrolytes and kidney function due to potential severity of some side effects. For example, ARBs can lead to severe effects on the fetus during pregnancy, including kidney conditions, skull or bone deformities, incomplete development of lung tissue, and death.

Moreover, ARBs can interact negatively with ACE inhibitors, dopamine receptor inhibitors, potassium-sparing diuretics, potassium supplements, and nonsteroidal anti-inflammatory drugs. This interaction can increase the risk of high potassium, low blood pressure, and acute kidney failure.

ARBs are contraindicated for individuals with high potassium levels, low blood pressure, or when pregnant. People who become pregnant or believe they have become pregnant while taking ARBs should discontinue them immediately, unless it is necessary to save their life.

In summary, dizziness and fatigue are among the most commonly reported side effects, often mild and temporary, while monitoring for changes in electrolytes and kidney function is crucial due to potential severity of some side effects. It's essential to consult with a healthcare provider for personalised advice on ARB usage and management of potential interactions with other medications.

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