Angiotensin II receptor blockers (ARBs)
One of the most irritating side effects for patients taking ACE inhibitors is the persistent dry cough and one of the most serious, the possibility of angioedema. The patient often complains mostly about the cough so may be given the alternative drug ARBs. There is still a chance of the cough and the angioedema but these side effects are usually less common.
ARBs work in a similar way to ACE inhibitors but they do not inhibit the breakdown of bradykinin or other kinins, and are thus rarely associated with the persistent dry cough although it is still given as a side effect. Like other antihypertensives, ARBs are associated with sexual dysfunction, but it is claimed that the incidence of ED is less likely with ARBs.
For those patients with narrowing of the arteries to the kidneys, they may experience diminishing kidney function which is not good!
What are the side effects of ARBs?
Common side effects include:
- back pain
- nasal congestion
- renal impairment
- low blood pressure
- muscle cramps or bone pain
- abnormal liver function
- sexual dysfunction
Serious but rare side effects include:
- Kidney failure
- Liver failure
- Allergic reactions
- Low white blood cells
- Swelling of tissues (angioedema)
If a patient has experienced serious side effects with an ARB they should be prescribed different medication. Again pregnant women must avoid using ARBs because they have the same risks as ACE inhibitors, birth defects.
Other side effects?
It would appear that some side effects have been missed off the list. Apart from an increased cancer risk and the chance of birth defects, there has been a law suit that’s just been settled for $300 million. According to Reuters : Daiichi Sankyo on Tuesday said it has agreed to pay up to $300 million to settle some 2,300 U.S. cases accusing the Japanese drugmaker of failing to warn that its blood pressure medication Benicar can cause gastrointestinal illness. So let’s just put these extra 3 side effects here shall we:
- Risk of cancer, in particular lung cancer
- Risk of birth defects (see Part 2 of this article)
- Risk of gastrointestinal illnesses
- Novartis AG’s Diovan
- Daiichi Sankyo Co.’s Benicar
- Merck & Co.’s Cozaar
- Boehringer Ingelheim GmbH’s Micardis
- Avapro, from Sanofi SA and Bristol-Myers Squibb Co.
- AstraZeneca PLC’s Atacand
These drugs are commonly used for:
- Hypertension (high BP)
- Heart failure
- Following a heart attack
- Chronic kidney disease?
As for taking ARBs to help chronic kidney disease, I read this on the British Heart Foundation website which somewhat confused and worried me, especially as kidney failure is on the serious side effects list for ARBs.
“After you start the drug, you’ll need another blood-test to check your kidney function. In some cases, ARBs can upset the kidneys, especially if the blood vessels to your kidneys are narrowed (renal artery stenosis).”
If I were taking ARBs for chronic kidney disease (CKD), I would really need to know why a drug that has a possible side effect of kidney failure, albeit rare, is being prescribed for CKD? The reasoning behind this would have to be really solid and independently researched for me to take this drug. Apart from the threat of an increased cancer risk and gastrointestinal diseases.
You can’t have enough independent research
There has been some research on this CKD medication but looking at it, the results appear a bit spurious especially as some of the data are admittedly missing as stated – They noted some limitations of the study, however, including the lack of information on actual levels of renal function, blood pressure, proteinuria, and some important patient characteristics. The study authors pointed out, too, that an observational study cannot prove causality. I hope this is not the only study they are going by to prescribe these drugs for CKD?
Beta blockers, otherwise known as beta-adrenergic blocking agents are drugs that are given to a patient to reduce blood pressure. They work by blocking the effects of epinephrine, better known as adrenaline. Taking these drugs will reduce your heart rate so your heart beats with less force which should reduce your blood pressure.
The following are some of the more common side-effects.
- Fatigue and tiredness
- Cold hands and feet
- A slow heart rate
- Dizziness. If your heartrate drops too low and/or you faint or feel dizzy, see your medic.
- Nightmares and sleeping problems
- sexual dysfunction or ED
- visual disturbances/hallucinations
The Safety of Beta Blockers
There has been much controversy over the past few years, regarding the safety of beta blockers, especially with regards to using the drugs for non-cardiac surgery patients. Many people may have died as a consequence of receiving this medication based on guidelines from what is now found to be discredited science.
Cardiac researcher fired
The cardiac researcher, Don Poldermans, who was discredited and fired back in 2011, was the chairman of the committee that drafted the guidelines for the European protocol and ‘standard of care’. His studies were found to be flawed and the extent of his scientific misconduct has not been established but appears to be extensive.
It is a sign of the times now that research specifically done by the pharmaceuticals, is often shady with conflicts of interest and research findings massaged for the benefit of the drug companies’ future sales of the products being studied. A most prestigious journal wrote the following, just a part of a scathing article about the state of medical research today
“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.” Richard Horton, The Lancet
800,000 feared dead
As for the discredited beta blocker study, it is estimated that 800,000 patients in Europe may have died as a result of this misconduct. The guidelines were set on the basis of this distorted research and if a physician decided not to follow the guidelines, he/she would be at risk of being medically reprimanded.
In one study,² use of beta-blockers before during and after surgical procedures found that those more likely to die because of the drugs, were patients with the lowest cardiac risk. On the other hand patients that had serious pre-existing heart problems were probably helped by the giving of beta blockers perioperatively.³
The last of this series of posts on blood pressure : what drugs are you on, will discuss the last drug on our list Renin Inhibitors and a determination of the options you have if you find you suffer from hypertension.