Which medications in the drug class Angiotensin Receptor Blockers (ARBs) are used in the treatment of Renovascular Hypertension?

Updated: Dec 01, 2020
  • Author: Rebecca J Schmidt, DO, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Angiotensin Receptor Blockers (ARBs)

Angiotensin II is the primary vasoactive hormone of the renin-angiotensin-aldosterone system (RAAS) and plays an important role in the pathophysiology of hypertension. Besides being a potent vasoconstrictor, angiotensin II stimulates aldosterone secretion by the adrenal gland; thus, angiotensin receptor blockers (ARBs) decrease systemic vascular resistance without a marked change in heart rate by blocking the effects of angiotensin II.

Type I angiotensin receptors are found in many tissues, including vascular smooth muscle and the adrenal gland. Type II angiotensin receptors also are found in many tissues, although their relationship to cardiovascular hemostasis is not known. The affinity of ARBs for the type I angiotensin receptor is approximately 1000 times greater than that for the type II angiotensin receptor.

In general, ARBs do not inhibit ACE, other hormone receptors, or ion channels. They interfere with the binding of formed angiotensin II to its endogenous receptor. Experience with using ARBs to treat RVHT is still limited. Losartan and valsartan are specific and selective nonpeptide ARBs that block the vasoconstricting and aldosterone-secreting effects of angiotensin II.

Other ARBs have been approved by the US Food and Drug Administration (FDA), including olmesartan (Benicar). Olmesartan is initiated at a dosage of 20 mg/day orally, which may be increased to 40 mg/day after 2 weeks if further blood pressure reduction is required.

Losartan (Cozaar)

Losartan is appropriate for patients unable to tolerate ACE inhibitors. It may induce a more complete inhibition of the RAAS than ACE inhibitors do, it does not affect the response to bradykinin, and it is less likely to be associated with cough and angioedema. Compared to the ACE inhibitors (eg, captopril and enalapril), losartan is associated with a lower incidence of drug-induced cough, rash, and taste disturbances.

Valsartan (Diovan)

Valsartan is appropriate for patients unable to tolerate ACE inhibitors. It may induce a more complete inhibition of the RAAS than ACE inhibitors do, it does not affect the response to bradykinin, and it is less likely to be associated with cough and angioedema. Compared to the ACE inhibitors (eg, captopril and enalapril), losartan is associated with a lower incidence of drug-induced cough, rash, and taste disturbances.


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