Which medications in the drug class ARBs are used in the treatment of Hypertension?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

ARBs

Generally, ACE inhibitors should remain the initial treatment of choice for hypertension. Angiotensin II receptor antagonists or angiotensin receptor blockers (ARBs) are used for patients who are unable to tolerate ACE inhibitors. ARBs competitively block binding of angiotensin-II to angiotensin type I (AT1) receptors, thereby reducing effects of angiotensin II–induced vasoconstriction, sodium retention, and aldosterone release; the breakdown of bradykinin should not be inhibited. If monotherapy with an ARB is not sufficient, adding a diuretic should be considered.

ARBs can cause injury or even death to a developing fetus. If a patient becomes pregnant, ARBs should be discontinued as soon as possible.

Note that a study by Harel et al found an increased risk for hyperkalemia when aliskiren and ARBs or ACE inhibitors were used together [145] ; therefore, careful monitoring of serum potassium levels is warranted when these agents are used in combination. [145] Furthermore, in patients with hypertension and type 2 diabetes and renal impairment who are at high risk of cardiovascular and renal events, there is an increased risk of nonfatal stroke, renal complications, hypokalemia, and hypotension when aliskiren is added to ACE inhibitor or ARB therapy.

Losartan (Cozaar)

Losartan may be used alone or in combination with other antihypertensive agents, including diuretics. The initial dose is 50 mg daily; however, in patients on diuretic therapy, the initial dose is 25 mg daily. A low-dose diuretic (eg, hydrochlorothiazide) may be added if blood pressure is not controlled. Losartan can be titrated up to 100 mg daily.

Valsartan (Diovan)

Valsartan is approved for the treatment of hypertension in adults and in children 6-16 years of age. It may be used alone or in combination with other antihypertensive agents. The initial dose is 80 or 160 mg once daily when used as monotherapy in patients who are not volume depleted. The valsartan dose may be increased (maximum 320 mg/day), or a diuretic may be added if additional blood pressure reduction is required. The addition of a diuretic has a greater effect than dose increases above 80 mg.

Olmesartan (Benicar)

Olmesartan is indicated for hypertension either alone or in combination with other antihypertensives. The initial dose is 20 mg daily when used as monotherapy. The dose may be titrated to 40 mg daily if greater effect is desired. Doses greater than 40 mg have not been shown to have greater effects. If monotherapy is not sufficient, adding a diuretic should be considered.

Eprosartan (Teveten)

Eprosartan may be used alone or in combination with other antihypertensives, such as diuretics and calcium channel blockers. The initial dose is 600 mg once daily when used as monotherapy in patients who are not volume depleted. The dose may be titrated if clinical response is not sufficient. The usual dosage range is 400-800 mg once or twice daily.

Azilsartan (Edarbi)

Azilsartan is indicated for hypertension, either alone or in combination with other antihypertensives. The usual dose is 80 mg once daily. Consider starting with an initial dose of 40 mg once daily in patients receiving high-dose diuretics.


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