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drug interaction(s) of ACE inhibitors with angiotensin II receptor antagonists

Drug interactions: 1) ARBs potentiate adverse effects of ACE inhibitors: [1] a) symptomatic hypotension b) renal failure c) hyperkalemia 2) combining ACE inhibitor with ARB does not improve outcomes [2,5,6] - addition of ARB to ACE inhibitor + beta-blocker worsens outcomes in patients with systolic heart failure [7] 3) combination results in small increase in risk of cancer (14%) [3] Management: - ARB as effective as ACE inhibitor in management of patients at high risk for cardiovascular events [2]

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DRUGS: ACE inhibitor angiotensin II receptor antagonist

References

  1. Phillips CO, Kashani A, Ko DK, Francis G, Krumholz HM. Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction: a quantitative review of data from randomized clinical trials. Arch Intern Med. 2007 Oct 8;167(18):1930-6. Review. PMID: 17923591
  2. Yusuf S et al for the ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008, 358:1547 PMID: 18378520
  3. Bangalore S et al Antihypertensive drugs and risk of cancer: network meta- analyses and trial sequential analyses of 324 168 participants from randomised trials The Lancet Oncology, Early Online Publication, 30 November 2010 PMID: 21123111 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(10)70260-6/fulltext
  4. Makani H et al Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. BMJ 2013;346:f360 PMID: 23358488 http://www.bmj.com/content/346/bmj.f360
  5. Fernandez Juarez G et al. Effect of dual blockade of the renin-angiotensin system on the progression of type 2 diabetic nephropathy: A randomized trial. Am J Kidney Dis 2013 Feb; 61:211 PMID: 22939518
  6. Fried LF et al Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy. N Engl J Med. 2013 Nov 9. [Epub ahead of print] PMID: 24206457 - de Zeeuw D. The End of Dual Therapy with Renin-Angiotensin-Aldosterone System Blockade? N Engl J Med. 2013 Nov 9. [Epub ahead of print] PMID: 24206456
  7. Prescriber's Letter 10(5):26 2003