Cardiology · USMLE Step 1 and Step 2

Angiotensin Receptor Blockers song

Angiotensin Receptor Blockers - ARBs vs ACE, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Angiotensin Receptor Blockers

Full song on YouTube ↗Spotify ↗

Key points in this song10

ARBs block the AT1 receptor, preventing angiotensin II from causing vasoconstriction and aldosterone release, thereby lowering blood pressure and reducing cardiac afterload.
Unlike ACE inhibitors, ARBs do not inhibit bradykinin breakdown, so they do NOT cause a dry cough or angioedema — making them the preferred alternative when ACE inhibitor cough occurs.
ARBs are first-line in hypertension with diabetic nephropathy, reducing proteinuria and slowing progression of chronic kidney disease by dilating the efferent arteriole.
Key ARBs to know: Losartan, Valsartan, Candesartan, and Irbesartan — all end in "-sartan."
ARBs are contraindicated in bilateral renal artery stenosis because efferent dilation drops GFR critically, precipitating acute kidney injury.
Major adverse effects include hyperkalemia and elevated creatinine; monitor potassium and renal function at initiation and dose changes.
ARBs are absolutely contraindicated in pregnancy (Category D/X) due to fetal renal dysgenesis, oligohydramnios, and limb contractures — the "ACEI/ARB fetopathy."
Valsartan is used in heart failure with reduced ejection fraction (HFrEF) and post-MI to reduce mortality, particularly in ACE inhibitor-intolerant patients.
The combination of an ARB with an ACE inhibitor is contraindicated due to increased risk of hypotension, hyperkalemia, and acute kidney injury without added mortality benefit.
Losartan has a unique uricosuric effect — it blocks uric acid reabsorption in the proximal tubule, making it the preferred ARB in hypertensive patients with gout.