Angiotensin-Receptor Blockers for Heart Failure - ARBs and Heart Disease

How Do ARBs Work, and Who Should Take Them?

The angiotensin II hormone contributes to heart disease in a number of ways. It narrows blood vessels, which raises blood pressure and makes the heart work harder. Angiotensin also contributes to the retention of sodium and water, as well as making the walls of the heart and blood vessels thicker and stiffer -- these, too, can increase blood pressure. By blocking the receptors for angiotensin, ARBs allow blood vessels to widen, which reduces blood pressure and lets the heart pump blood more effectively with less effort.

ARBs may be prescribed in combination with angiotensin-converting enzyme (ACE) inhibitors, which inhibit the production of angiotensin. A combination of the two medications has been shown to be effective for patients who still have symptoms of high blood pressure or heart failure, despite using ACE inhibitors. ARBs alone are usually prescribed for patients who do not tolerate ACE inhibitors well.

Although ARBs are generally prescribed for heart failure and high blood pressure, they are also used for patients who have kidney failure related to diabetes, chronic kidney disease or scleroderma.

Research presented in 2008 found that ARBs may also have a beneficial effect on the occurrence and progression of Alzheimer's disease and dementia; high blood pressure has also been associated with Alzheimer's and dementia.

ARBs are available in the United States only by prescription, and there are no generic equivalents offered yet. Examples of ARBs include the following: Cozaar (losartan), Diuovan (valsartan), Avapro (irbesartan), Atacand (candesartan), Micardia (telmisartan), Benicar (olmesartan) and Teveten (eprosartan).

ARBs are well tolerated by most patients. The most common side effects of ARBs include headaches, nausea, dizziness, nasal congestion, upper respiratory tract infection, back and leg pain, diarrhea and low blood pressure. In rare cases, ARBs have been associated with liver failure, kidney failure, allergic reactions, facial swelling, difficulty breathing and a drop in white blood cell counts.

Women who are pregnant, or who are planning to become pregnant, should avoid the use of ARBs because they may cause birth defects.

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