Cardiovascular Medicine Book

Congestive Heart Failure

Coronary Artery Disease

Electrocardiogram

Examination

Hyperlipidemia

Hypertension

Miscellaneous

Pericardial Disorders

Obstetrics Chapter related topics

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Angiotensin 2 Receptor Blocking AgentAka: Angiotensin Receptor Blocker, Losartan, Cozaar, Irbesartan, Avapro, Candesartan, Atacand, Eprosartan, Teveten, Telmisartan, Micardis, Valsartan, Diovan, Olmesartan, Benicar, Angiotensin Blocker

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  1. Indications
    1. Intolerance to ACE Inhibitor
    2. See ACE Inhibitor for indications
  2. Mechanism
    1. Renin-Angiotensin System
  3. Preparations
    1. Losartan (Cozaar)
      1. Start
        1. Normal: 50 mg PO qd (MAX 100 mg/day)
        2. Volume depleted: Start at 25 mg qd
      2. Takes 4-6 weeks to see peak effect
    2. Irbesartan (Avapro)
      1. Start 150 mg PO qd (max 300 mg/day)
    3. Candesartan (Atacand) 8 mg PO qd (maximum 32 mg/day)
    4. Eprosartan (Teveten) 400 mg PO qd (maximum 800 mg/day)
    5. Telmisartan (Micardis) 40 mg PO qd (maximum 80 mg/day)
    6. Valsartan (Diovan) 80 mg PO qd (maximum 320 mg/day)
    7. Olmesartan (Benicar) 20 mg PO qd (maximum 40 mg PO qd)
  4. Efficacy
    1. Not as effective as ACE Inhibitors in MI prevention
      1. ARBs do not effect Angiotensin II type 2 receptors
      2. Results in less effect on fibrosis and blood flow
      3. Unlike ACE Inhibitors, ARBs don't effect nitric oxide
      4. (2005) Prescriber's Letter 12:31-2
    2. Reduces cardiovascular death, CVA and MI risk
      1. Higher level cardiovascular protection than Atenolol
      2. Dahlof (2002) Lancet 359:995
  5. References
    1. Burnier (2000) Lancet 355(9204):637
    2. Califf (2000) Am Heart J 139:S15
    3. Jacobsen (2001) {a 6607} 56(2):20

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