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(Hypertension. 2001;37:e1.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Are Angiotensin II Receptor Antagonists Safe in Patients With Previous Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema?

Sabine A. Fuchs; Richard P. Koopmans; Henk-Jan Guchelaar

Departments of Clinical Pharmacy and Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands

Carrie C. E. Brodie-Meijer

The Netherlands Pharmacovigilance Foundation LAREB, Amsterdam, The Netherlands

Ronald H. B. Meyboom

The WHO Uppsala Monitoring Centre, Uppsala, Sweden

	Introduction

 
To the Editor:

We describe the results of a literature and pharmacovigilance survey on the clinically relevant problem of whether angiotensin II receptor antagonists (ARAs) can be safely used in patients with previous angiotensin-converting enzyme (ACE) inhibitor–induced angioedema. The results suggest that patients with previous ACE inhibitor–induced angioedema are at increased risk for relapse angioedema during the use of an angiotension II receptor antagonist, and therefore angiotensin II antagonist should not be considered a safe substitute in patients with previous ACE inhibitor–induced angioedema.

ACE inhibitors (ACEIs) are widely applied as blood pressure–lowering agents. Although ACEIs are generally well tolerated, they are also involved in the activation of bradykinin, enkephalins, and other biologically active peptides, which may result in adverse effects such as cough, increased bronchial reactivity, and angioedema. An attempt to achieve a more specific blockade of the effects of angiotensin II resulted in the introduction in 1995 of angiotensin II receptor antagonists (ARAs), starting with losartan and followed by irbesartan, valsartan, candesartan, and eprosartan. Because the pharmacology of ARAs is substantially different from ACEIs, the adverse effects associated with ACEIs were not anticipated. However, cases of cough and more rarely of angioedema attributed to the use of ARAs have repeatedly been described.^{1 2 3 4 5 6} The pharmacological mechanism of these effects remains to be clarified. Estimates of the incidence of ACEI-associated angioedema vary between 0.1% to 2%. The onset of angioedema after the first intake of ACEIs is usually within the first week of treatment (60%) but may also cover several years. . . . [Full Text of this Article]