Drug Class Guide
ARBs (Angiotensin II Receptor Blockers)
Blood pressure medicines that protect the heart and kidneys much like ACE inhibitors, but rarely cause a cough.
How ARBs Work
Angiotensin II is a hormone that narrows blood vessels and makes the body retain salt and water. ARBs block the receptor angiotensin II acts on, so blood vessels relax and blood pressure falls. Because they do not affect bradykinin, they seldom cause the dry cough seen with ACE inhibitors.
What ARBs Treat
ARBs in Our Medication Guide
- LosartanCozaarThe first ARB; also lowers uric acid slightly, which can help people with gout.
- ValsartanDiovanHigh blood pressure and heart failure; also combined with sacubitril as Entresto.
- IrbesartanAvaproApproved to slow kidney disease in people with type 2 diabetes and high blood pressure.
- CandesartanAtacandHigh blood pressure and heart failure.
- OlmesartanBenicarRarely causes a severe, celiac-like diarrhea that resolves after stopping it.
- TelmisartanMicardisLong-acting; also approved to lower cardiovascular risk in high-risk adults.
Common Side Effects
ARBs are generally well tolerated. Dizziness, higher potassium and changes in kidney blood tests are the main issues, so labs are checked after starting. Cough and angioedema can happen but are much less common than with ACE inhibitors.
Important Cautions
- Do not take an ARB during pregnancy; it can harm the developing baby.
- An ARB is generally not combined with an ACE inhibitor.
- Some lots of valsartan, losartan and irbesartan were recalled in 2018 and 2019 for impurities. If you hear of a recall, do not stop your medicine on your own; ask your pharmacist for a replacement.
Side-by-Side Comparisons
Common Questions About ARBs
Do ARBs cause a cough like ACE inhibitors?
Rarely. The ACE inhibitor cough comes from a buildup of bradykinin, which ARBs do not affect. That is the most common reason doctors switch a patient from an ACE inhibitor to an ARB.
Can ARBs protect the kidneys?
Yes. In people with diabetes or chronic kidney disease who have protein in the urine, ARBs and ACE inhibitors slow kidney damage. Irbesartan and losartan are specifically approved for kidney disease caused by type 2 diabetes.
Are all ARBs the same?
They share the same mechanism and lower blood pressure by similar amounts at equivalent doses. They differ in how long they last, which conditions they are approved for, and a few individual effects, such as losartan lowering uric acid.
This guide is general information, not a substitute for advice about your own medicines. Do not start, stop or switch a medication without talking with your doctor. Questions about a prescription? Our internal medicine team can help.
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Trusted Resources for ARBs
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