Angiotensin II Receptor Blockers in Patients with ACE Inhibitor–Induced Angioedema

Abstract

Until the exact cause of both ACE inhibitor- and angiotensin II receptor blocker-induced angioedema is determined, angiotensin II receptor blockers should be used with extreme caution in patients with a prior history of angioedema.

Antihypertensive drug-induced angioedema causing upper airway obstruction in children

“…If necessary, the medication should be replaced with an alternative drug from a different class [10]. However, when prescribing these medications in children and adolescents, it is important to note that diuretics, calcium channel blockers, ACE inhibitors, adrenoreceptor antagonists, and angiotensin-receptor blockers (ARBs) have all been reported to cause angioedema in adults [18][19][20].…”

“…Rather than a drug-specific effect, angioedema appears to be a class effect of all ACE inhibitors, independent of dose [7,20]. In contrast, CCB-induced angioedema appears to be related to specific drugs within the category [14,26].…”

“…They are presumed to be safe alternatives to ACE inhibitors as they do not increase bradykinin levels, the proposed mechanism of ACE inhibitorinduced angioedema [7]. However, this protective mechanism does not appear to be absolute, and recurrent angioedema has been reported when adults have been switched from an ACE inhibitor to an ARB [20,28]. Based on a meta-analysis by Beavers et al an estimated 10% or less incidence of cross reactivity exists between the two classes of drug.…”

Calcium Channel Blocker-associated Small Bowel Angioedema

“…[16][17][18][19][20][21] The mechanism of action is unclear because angiotensin II receptor antagonists have no demonstrable effect on local or systemic bradykinin levels. 16 Only rarely is isolated gastrointestinal involvement seen.…”

Systolic heart failure in the elderly: optimizing medical management

“…Angioedema is a life-threatening side effect that can occur with ACE inhibitor use in less than 1% of patients [26]. The substitution of an ARB for ACE inhibitor in this case should be done cautiously as angioedema can occur with ARB use as well [2,[28][29][30].…”