ACE INHIBITORS & ARB

SUMMARY

1. Angiotensin II increases BP by direct vasoconstriction, potentiation of the sympathetic system, increasing Na reabsorption in the PT, and stimulation of adrenal aldosterone production.

2. ACEI inhibit conversion of angiotensin I to II, causing a decrease in angiotensin II and aldosterone.

3. Angiotensin receptor blockers (ARBs) act at the angiotensin II receptor level.

4. ACEI/ARB result in dilatation of the efferent arteriole (after the glomerulus) => decreased glomerular capillary pressure.

5. This decreased glomerular pressure decreases progression of both diabetic & hypertensive nephropathies, and other types of CKD.

6. Know that the combination of an ACEI + ARB for treatment of HTN increases adverse events (ONTARGET trial). Pick an ACEI or an ARB but do not combine them.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].