Which medications in the drug class Angiotensin II Receptor Blockers are used in the treatment of Primary Aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Angiotensin II Receptor Blockers

Angiotensin II receptor blockers lower blood pressure by blocking the final receptor (ie, angiotensin II) in the renin-angiotensin axis. Like angiotensin-converting enzyme (ACE) inhibitors, they are contraindicated in pregnancy. Serum electrolyte and creatinine levels should be monitored. Irbesartan and losartan are examples of angiotensin II receptor blockers (ARBs). Interestingly, although primary aldosteronism is a condition associated with low plasma renin, aldosterone secretion seems to be exquisitely sensitive to even subnormal concentrations of angiotensin II. This phenomenon seems to be the basis for the efficacy of ARBs in primary aldosteronism (specifically idiopathic adrenal hyperplasia [IAH]).

Irbesartan (Avapro)

Irbesartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II at the tissue receptor site. It may induce a more complete inhibition of the renin-angiotensin system than do ACE inhibitors. In addition, irbesartan does not affect the response to bradykinin, and it is less likely to be associated with cough and angioedema.

Losartan (Cozaar)

Losartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II. It may induce a more complete inhibition of the renin-angiotensin system than ACE inhibitors do. In addition, losartan does not affect the response to bradykinin, and it is less likely to be associated with cough and angioedema. It is suitable for patients who are unable to tolerate ACE inhibitors.

Olmesartan (Benicar)

Olmesartan blocks the vasoconstrictor effects of angiotensin II by selectively blocking the binding of angiotensin II to angiotensin II type 1 receptors in vascular smooth muscle. Its action is independent of the pathways for angiotensin II synthesis.

Valsartan (Diovan)

Valsartan is a prodrug that displaces angiotensin II from angiotensin II type 1 receptors, blocking the vasoconstrictor effects of angiotensin II. Valsartan may also lower blood pressure through its effects on aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic responses.

Valsartan may induce a more complete inhibition of the renin-angiotensin system than ACE inhibitors do. In addition, it does not affect the response to bradykinin and is less likely to be associated with cough and angioedema. Valsartan is suitable for patients who are unable to tolerate ACE inhibitors.

Telmisartan (Micardis)

Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland and therefore reduces blood pressure. There is also an AT2 receptor found in many tissues, but AT2 is not known to be associated with cardiovascular homeostasis and telmisartan has much greater affinity for the AT1 receptor than for the AT2 receptor


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