When used in combination ACE inhibitors and ARBs are associated with an increased risk of symptomatic hypotension, acute renal failure and hyperkalemia and may increase mortality.

Conditions: Hypertension, High Blood Pressure (HBP), Diabetic Nephropathy, Heart Failure (HF)

Treatments: Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin II Receptor Blockers (ARBs)

Sources

• Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N. Engl. J. Med. Nov 14 2013;369(20):1892- 1903. (PubMed)
• Heran BS, Musini VM, Bassett K, Taylor RS, Wright JM. Angiotensin receptor blockers for heart failure. Cochrane Database Syst Rev. 2012;4:Cd003040. (PubMed)
• Mann JF, Schmieder RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. Aug 16 2008;372(9638):547-553. (PubMed)
• Phillips CO, Kashani A, Ko DK, Francis G, Krumholz HM. Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction: a quantitative review of data from randomized clinical trials. Arch. Intern. Med. Oct 8 2007;167(18):1930-1936. (PubMed)
• Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. Apr 10 2008;358(15):1547-1559. (PubMed)