Angiotensin receptor blockers as well as angiotensin converting enzyme (ACE) inhibitors have an effect on a natural substance called angiotensin that can raise blood pressure. Like ACE inhibitors, angiotensin receptor blockers appear to be less effective in lowering blood pressure in most African-Americans than other blood-pressure-lowering drugs.
Like the ACE inhibitors, these drugs also have the adverse effect of causing too high a potassium level in the blood. The angiotensin receptor blockers do not cause a dry, hacking cough as often as the ACE inhibitors.
Hive-like swelling beneath the skin, especially around the eyes and lips, (angioedema) and rare cases of breakdown or disintegration of muscle (rhabdomyolysis) have been reported in patients receiving an angiotensin II receptor blocker.
There were seven cases of rash reported to the Adverse Drug Reaction Advisory Committee in Australia between 1999 and November 2002. In these cases, candesartan was thought to be responsible.
The ACE inhibitors have a long-term protective benefit on the heart and kidneys, and information is now becoming available on the effect of the angiotensin receptor blockers in these conditions.
A study on diabetic patients with nerve damage (neuropathy) found that losartan (COZAAR) offered protection to the nerves (neuroprotection), but no reduction in the rate of death from cardiovascular causes. About 30% of patients died of cardiovascular events. In another study involving similar patients, irbesartan (AVAPRO) 
showed neuroprotection, but had a 24% incidence of cardiovascular events.
A study comparing the addition of the older angiotensin receptor blocker, valsartan (DIOVAN), or a placebo to standard treatment in patients with heart failure found that more people died taking valsartan than taking the placebo, though the difference was not statistically significant. A disturbing finding of this study is that in patients taking an ACE inhibitor plus a beta-blocker such as atenolol (TENORMIN) who were given valsartan were significantly more likely to do worse or die than those taking the placebo.
Valsartan (DIOVAN) was also compared to amlodipine (NORVASC), a calcium channel blocker, and patients taking both drugs were found to have similar overall rates of mortality and similar rates of cardiovascular mortality and illness from cardiovascular causes. However, the valsartan group had a higher incidence of fatal and non-fatal heart attacks (myocardial infarction) and chest pains caused by the heart receiving too little blood and oxygen (angina pectoris). The amlodipine group had a significantly lower incidence of myocardial infarction (a higher rate of new onset diabetes was found in the amlodipine group) and was more effective in reducing blood pressure especially during the early phase of treatment (the first 2 years).
There have been reports of spontaneous abortion, oligohydramnios (placenta insufficiency) and newborn renal (kidney) dysfunction when pregnant women have inadvertently, presumably not knowing they were pregnant, taken valsartan.
The angiotensin receptor blocker losartan (COZAAR) was compared to the ACE inhibitor captopril (CAPOTEN) to assess their effect on survival in patients with heart failure. Captopril was found superior to losartan in improving survival in these elderly heart failure patients.
The Food and Drug Administration (FDA) Cardiovascular and Renal Drugs Advisory Committee voted not to recommend the approval of the angiotensin receptor blocker irbesartan (AVAPRO) to curb kidney damage in patients with type-2 diabetes.
In 2005, the FDA approved candesartan (ATACAND) for the treatment of heart failure in patients with left ventricular systolic dysfunction to reduce cardiovascular deaths and to reduce heart failure hospitalizations.
The professional product label for candesartan (ATACAND) warns that caution should be observed when initiating therapy in patients with heart failure. Patients with heart failure given candesartan (ATACAND) commonly have some reduction in blood pressure. In the CHARM program, low blood pressure (hypotension) was reported in 18.8% of patients on candesartan (ATACAND) versus 9.8% of patients on placebo. The incidence of hypotension leading to drug discontinuation in candesartan-treated patients was 4.1% compared with 2.0% in placebo-treated patients. Monitoring of blood pressure is recommended while the drug dosage is being adjusted and periodically thereafter.
Hypotension (low blood pressure) may occur during major surgery and anesthesia in patients treated with angiotensin receptors blockers, including candesartan, due to blockade of the renin-angiotensisn system. Very rarely, hypotension may be severe enough to warrant the use of intravenous fluids and/or vasopressors (medication that raises blood pressure).
If you have high blood pressure, the best way to reduce or eliminate your need for medication is by improving your diet, losing weight, exercising, and decreasing your salt and alcohol intake. Mild hypertension can be controlled by proper nutrition and exercise. If these measures do not lower your blood pressure enough and you need medication, hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE), a water pill, should be used first, starting with a low dose. This drug also costs much less than other blood pressure drugs.
There is growing evidence that thiazide diuretics, such as hydrochlorothiazide, significantly decrease the rate of bone mineral loss in both men and women because they reduce the amount of calcium lost in the urine. Research now suggests that thiazide diuretics may protect against hip fracture.
If your high blood pressure is more severe, and hydrochlorothiazide alone does not control it, the best treatment is a combination of hydrochlorothiazide and a second type of drug called a beta-blocker, such as propranolol (INDERAL, INDERAL LA). If you can’t take a drug in the beta-blocker family, another family of high-blood-pressure-lowering drugs may be added to your treatment. In either case, your doctor would prescribe the hydrochlorothiazide and the second drug separately, with the dose of each drug adjusted to meet your needs, rather than using a product that combines the drug in a fixed combination.
should regularly check the levels of the drug in your blood. You and your doctor should also watch for the subtle symptoms of toxicity: fatigue, loss of appetite, nausea and vomiting, problems with vision, bad dreams, nervousness, drowsiness, and hallucinations. Other signs of toxicity are changes in heart rhythm, slow pulse, and lethargy. Since there is a narrow range between a helpful and a harmful amount of 
kidney failure. ACE inhibitors may also be the preferred class of drugs to control blood pressure in those people with kidney damage from diabetes. However, ACE inhibitors can cause dangerous adverse effects such as bone marrow depression and, ironically, kidney disease itself, and therefore should be taken in lower doses by older adults. This may amount to less than one-third the doses used in the past. In general, patients are more likely to suffer harmful effects from ACE inhibitors if they have decreased kidney function, including dehydration. Since older adults generally have some decrease in kidney function, these drugs may be especially dangerous for them. In older adults, therefore, use of an ACE inhibitor requires a careful balancing of the risks and benefits by the patient with his or her physician.
possibility of birth defects in children born to mothers who took angiotensin-converting enzyme (ACE) inhibitors during the first trimester of pregnancy.
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