2.5.5.2 Angiotensin-II receptor antagonists (AIIRAs/ARBs)
Hypertension
| Choice | Drug |
|---|
| 1st choices | Candesartan tablets 2mg, 4mg, 8mg, 16mg, 32mg |
| or |
| Losartan tablets 12.5mg, 25mg, 50mg, 100mg |
| |
Heart Failure
| Choice | Drug |
|---|
| 1st choice | Candesartan tablets 2mg, 4mg, 8mg, 16mg, 32mg |
| 2nd choice | Valsartan capsules 40mg, 80mg, 160mg, |
| |
Diabetic nephropathy in type II diabetes mellitus
| Choice | Drug |
|---|
| 1st choice | Losartan tablets 12.5mg, 25mg, 50mg, 100mg |
| 2nd choice | Irbesartan tablets 75mg, 150mg, 300mg |
| |
Prescribing Notes
- Refer to NICE NG136 hypertension guidance and NICE heart failure guidance NG106.
- Monitoring requirements are the same for ACE inhibitors and ARBs.
- ACE inhibitors and ARBs are contra-indicated in pregnancy and should be avoided in patients who become pregnant.
- The combination of an ACE inhibitor and ARB may cause increased adverse events and is not recommended. Refer to MHRA
- For the prescribing of sacubitril/valsartan (Entresto®) see 2.5.5.1
Cautions
- Patients taking ACE inhibitors or ARBs should be informed that they are at an increased risk of Acute Kidney Injury (AKI) if they develop an illness associated with hypovolaemia and hypotension. ACE inhibitors and ARBs should be stopped temporarily. Refer to ‘sick day guidancee’ for further information.
- As elderly patients are at particular risk of renal impairment, renal function should be monitored pre-treatment in patients taking ARBs. Regular U&E checks may be needed after initiation
- Initiation of ACE inhibitors or ARBs may precipitate hypotension in patients with severe aortic stenosis or outflow obstruction. Therefore use with caution and under the direction of a specialist.
- Caution is required in patients who may have renovascular disease. ARBs should be used with caution in patients with renal artery stenosis.
