How do ARBs differ from ACE inhibitors in adverse effects and when is an ARB likely to be prescribed?

How do ARBs differ from ACE inhibitors in adverse effects and when is an ARB likely to be prescribed?

• A. ARBs cause more cough and angioedema; prescribed for those who tolerate ACE inhibitors well.
• B. ARBs have less cough/angioedema; prescribed for those who cannot tolerate ACE inhibitors; same indications: HTN, HF, CKD.
• C. ARBs cause more angioedema than ACE inhibitors; used only for CKD.
• D. ARBs are never used if ACE inhibitors are tolerated.

Answer: (B)

ARBs differ from ACE inhibitors mainly in the adverse effect profile because they don’t increase bradykinin levels. ACE inhibitors can cause a cough and, in some patients, angioedema due to bradykinin accumulation. ARBs block the angiotensin II receptor without boosting bradykinin, so they have a much lower risk of cough and angioedema. This makes ARBs the preferred choice for patients who experience cough or angioedema with ACE inhibitors or who cannot tolerate them for those reasons. The uses of ARBs overlap with those of ACE inhibitors and include treating hypertension, heart failure, and chronic kidney disease, so they’re prescribed when these conditions need angiotensin II pathway blockade but the patient cannot take an ACE inhibitor. While ARBs still carry a small risk of angioedema, it is much less common than with ACE inhibitors.

ARBs differ from ACE inhibitors mainly in the adverse effect profile because they don’t increase bradykinin levels. ACE inhibitors can cause a cough and, in some patients, angioedema due to bradykinin accumulation. ARBs block the angiotensin II receptor without boosting bradykinin, so they have a much lower risk of cough and angioedema. This makes ARBs the preferred choice for patients who experience cough or angioedema with ACE inhibitors or who cannot tolerate them for those reasons. The uses of ARBs overlap with those of ACE inhibitors and include treating hypertension, heart failure, and chronic kidney disease, so they’re prescribed when these conditions need angiotensin II pathway blockade but the patient cannot take an ACE inhibitor. While ARBs still carry a small risk of angioedema, it is much less common than with ACE inhibitors.