Manufacturers note that hypotension and dizziness can happen while taking an angiotensin receptor blocker (ARB), particularly for patients who are volume- or salt-depleted.1-8 Examples include those who:
- take water pills (diuretics)
- are on a low-salt diet
- take other medicines that affect your blood pressure
- get sick with vomiting or diarrhea
- do not drink enough fluids
If hypotension does occur, the patient should lie down and may need an intravenous infusion of normal saline.1-8 Transient hypotensive episodes are not a contraindication to further treatment. Once blood pressure is stabilized, most patients can continue treatment without difficulty.
Some studies have shown that ARBs are not significantly associated with hypotension when taken for essential hypertension.9,10 Some studies have found an increased risk of hypotension with ARBs.11,12
A 2015 retrospective study of 9,242 patients with essential hypertension referred to a hypertension clinic examined the prevalence of orthostatic hypotension (OH).9 Combination drug therapies including α-blockers, centrally acting drugs, non-dihydropyridine calcium-channel blockers, and diuretics were found to have a significant association with OH. This study found that ARBs appear to not be significantly related with OH compared to other antihypertensives. They may, in fact, have the potential to protect people from developing OH.
In a 1996 study of 736 hypertensive adults randomized to receive placebo or valsartan 20, 80, 160, or 320 mg daily, no cases of symptomatic OH occurred.10
A 2012 review of randomized controlled trials found ARBs were significantly associated with a higher rate of hypotension (risk ratio [RR] 2.59, 95% confidence interval [CI] [1.77 – 3.92]; four RCTs, n=8,590) compared to placebo.11
A 2015 meta-analysis of 16 randomized controlled trials encompassing 113,386 patients with a mean age of 65 years or older, found ARBs were associated with an increased risk of hypotension (RR 1.56, 95% CI [1.24 – 1.97], p<0.001) compared to placebo.12
References
- Edarbi [package insert] Atlanta, GA: Arbor Pharmaceuticals, LLC; 2016.
- Benicar [package insert] Parsippany, NJ: Daiichi Sankyo, Inc; 2009.
- Micardis [package insert] Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; 2014.
- Teveten [package insert]. North Chicago, IL: AbbVie Inc.; 2014.
- Cozaar [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2015.
- Avapro [package insert] Bridgewater, NJ: Sanofi-Aventis U.S. LLC; 2016.
- Atacand [package insert] Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2016.
- Diovan [package insert] East Hanover, NJ: Novartis Pharmaceuticals Corp; 2017.
- Di Stefano C, Milazzo V, Totaro S, et al. Orthostatic hypotension in a cohort of hypertensive patients referring to a hypertension clinic. J Hum Hypertens 2015; 29 (10): 599-603.
- Oparil S, Dyke S, Harris F, et al. The efficacy and safety of valsartan compared with placebo in the treatment of patients with essential hypertension. Clin Ther 1996; 18 (5): 797-810.
- Caldeira D, David C, Sampaio C. Tolerability of angiotensin-receptor blockers in patients with intolerance to angiotensin-converting enzyme inhibitors: A systematic review and meta-analysis. Am J Cardiovasc Drugs 2012; 12 (4): 263-277.
- Elgendy IY, Huo T, Chik V, Pepine CJ, Bavry AA. Efficacy and safety of angiotensin receptor blockers in older patients: A meta-analysis of randomized trials. Am J Hypertens 2015; 28 (5): 576-585.
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