Okay, let’s talk about angiotensin II receptor blocking
we call those ARBs for short so let’s run with that from
here on out.
How these guys work is they block the vasoconstriction
effects of angiotensin II
because they block access to the receptors; so when you give
someone an ARB,
you put the drug on that angiotensin II receptor and it
blocks it, so even though you have lots of angiotensin II
from the RAAS,
it’s all dressed up and no place to go because you have
wisely blocked that receptor with an ARB.
Now, these guys have an ending that’s the same too, it’s
which I love the picture that the Lecturio graphic artist
like she’s blocking her face from the sun. So this will help
to remind you, this is a blocker and it ends in TAN -
olmesartan, telmisartan, irbesartan, losartan -- it’s all
tan, tan, tan.
So while you're in that mode, see if you can pause and
recall what is the four letter ending for ACE inhibitors?
Now with ARBs, we’ll talk about the types of patients that
we would use these for.
Many of the ARBs have some different applications with
cardiovascular health and I’m gonna go over those
but all of them treat hypertension, so each of the ARBs, the
angiotensin II receptor blocking agents treat hypertension,
but two of them -- irbesartan, losartan -- are used for
Losartan is also used for diabetic retinopathy -- challenge
to the eyes.
Valsartan is used after a heart attack, a myocardial
infarction or MI.
Losartan is also approved to reduce the stroke risk in
hypertensive patients with left ventricular hypertrophy.
So left ventricle -- I know you know what that means --
we're talking about the heart.
Hypertrophy means -- hyper means big or elevated, trophy
So we can use Losartan to reduce the risk of people who have
high blood pressure with that left ventricle that’s gotten
Remember the left ventricle gets too big because the SVR,
the systemic vascular resistance is high after the heart
probably because the vessels have a narrow diameter,
or they might be narrowed because either of
vasoconstriction, right, those arteries has been constricted
or they could have coronary artery disease and those vessels
are kind of filling up with plaque
so because that heart has had to work to so hard and it’s
the left ventricles job to push blood
throughout the rest of the body when you over work it like
that with hypertension it becomes hypertrophy,
hypertrophy that gets bigger to try to overcome that and
eventually that’s gonna become a real problem for your
Now for patients who are a little bit older if you’re pretty
young you think 55 is like wow,
geriatric, but I promise you, as you get close to that age,
it doesn’t seem quite so old;
but we have patients who are 55 plus or they can’t tolerate
because remember those three side effects that spell A-C-E?
Write those in the margin of your notes see if you can
remember the three side effects of ACE inhibitors that stand
Now add just a couple more to see what a rock star that you
are for ACE inhibitors.
Okay if somebody is 55 and over, somebody who can't tolerate
an ACE inhibitor
and they have some cardiovascular risk like they’ve had a
heart attack before, they’ve had a stroke -
we’re gonna help reduce those risk so telmisartan is the one
that we recommend for that -
if they’ve had some type of other MI or cardiovascular
Now what are the side effects?
Well, remember for -- cuz I know you just wrote them down
for ACE inhibitors,
you can also have some angioedema, a small risk for this
Now, it has a lower risk of cough than ACE inhibitors do,
but they still might also develop a cough with an ARB, so
they may or may not develop that cough.
Remember, we don’t use ACE inhibitors for people who are
and you shouldn’t use ARBs for patients who are pregnant,
that’s why it’s in a big red box for you there.