Angiotensin II Receptor Blocker Combination Therapy

Introduction to ARB Therapy

The European Society of Cardiology recommends against dual blockade of the renin-angiotensin system (RAS) with two ARBs, as it is specifically advised against in current hypertension guidelines 1
The American College of Cardiology advises that taking both losartan and irbesartan together increases risks without providing additional blood pressure-lowering benefits 2

The American College of Cardiology states that combining two ARBs increases the risk of hypotension (low blood pressure) 2
The European Society of Cardiology recommends that no additional therapeutic benefit is gained from combining two ARBs compared to optimal dosing of a single ARB 1

The American College of Cardiology recommends using a single ARB for hypertension treatment, not multiple ARBs 3, 4, 5
The American Heart Association suggests that if blood pressure control is inadequate with one ARB, the dose of the single ARB should be optimized (e.g., losartan 50-100mg or irbesartan 150-300mg) before adding a medication from a different class 3, 5
The European Society of Cardiology recommends adding a medication from a different class, such as a thiazide diuretic or calcium channel blocker, if blood pressure control is inadequate with one ARB 6, 1

The American College of Cardiology suggests that for resistant hypertension, an aldosterone antagonist like spironolactone should be considered rather than a second ARB 2
The European Society of Cardiology recommends that if more blood pressure control is needed, a thiazide diuretic or calcium channel blocker should be added to a single ARB 6, 1