ACEhemmereARB

ACEhemmereARB refers to two major classes of medicines that modulate the renin-angiotensin system: ACE inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs). Both are widely used in cardiovascular and kidney diseases to lower blood pressure, reduce cardiovascular events, and protect organ function, but they act through different mechanisms.

ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II, leading to lower angiotensin II levels and reduced vasoconstriction and aldosterone release. They also increase bradykinin, which can contribute to vasodilation but may cause cough or, rarely, angioedema. ARBs selectively inhibit the angiotensin II type 1 receptor, preventing angiotensin II from exerting its effects without increasing bradykinin.

Common ACE inhibitors include enalapril, lisinopril, ramipril, and captopril. Common ARBs include losartan, valsartan, candesartan, telmisartan, and olmesartan. Both classes are used for hypertension and are foundational in the treatment of heart failure with reduced ejection fraction, post-myocardial infarction, and diabetic or proteinuric kidney disease. They may be chosen or switched based on patient tolerance, comorbidities, and pregnancy status, as these drugs are contraindicated in pregnancy and require monitoring for kidney function and electrolyte balance.

Safety considerations include the risk of hyperkalemia and possible kidney function decline, particularly in people with chronic kidney disease or dehydration. ACE inhibitors carry a higher risk of cough and, rarely, angioedema compared with ARBs. In most conditions, guidelines discourage combining an ACE inhibitor with an ARB, as combination therapy has not shown added benefit and can increase adverse events, as seen in large trials.