Sartans

Sartans, or angiotensin II receptor blockers (ARBs), are a class of antihypertensive medications that selectively block the angiotensin II type 1 (AT1) receptor. This prevents angiotensin II–mediated vasoconstriction and aldosterone release, leading to vasodilation and reduced blood pressure. Unlike ACE inhibitors, ARBs do not inhibit bradykinin breakdown, so they are less likely to cause cough or angioedema, though such effects can still occur.

Common agents include losartan, valsartan, irbesartan, candesartan, telmisartan, olmesartan, and eprosartan. Many are taken by mouth; several are prodrugs that are converted to active metabolites (for example, losartan, candesartan cilexetil, olmesartan medoxomil).

Clinical uses include hypertension, heart failure with reduced ejection fraction, and slowing progression of diabetic nephropathy with albuminuria. They are often used as an alternative to ACE inhibitors in patients who develop cough or angioedema. They may be used after myocardial infarction in certain patients to reduce mortality and heart failure risk. They are contraindicated in pregnancy and should be used with caution in severe renal impairment or bilateral renal artery stenosis due to the risk of hyperkalemia.

Adverse effects are generally mild but include hyperkalemia, dizziness, hypotension, and, less commonly, angioedema. Drug interactions include potential increased potassium with potassium-sparing diuretics or supplements and reduced effect with NSAIDs.