ARB Medications: Clinical Guidelines and Recommendations

Introduction to ARB Therapy

The American Heart Association recommends the use of ARBs, such as candesartan or valsartan, as first-line therapy for heart failure with reduced ejection fraction, with equivalent efficacy to ACE inhibitors 3
The American College of Cardiology recommends the use of sacubitril-valsartan (ARNI) over standard ARBs or ACE inhibitors for improved outcomes in heart failure patients 4

For patients with heart failure and reduced ejection fraction, the target doses are candesartan 32 mg daily, valsartan 160 mg twice daily, and losartan 150 mg daily, as recommended by the American College of Cardiology 1, 3
In patients with diabetic nephropathy, irbesartan 300 mg daily is recommended for early nephropathy, and irbesartan 300 mg daily or losartan 100 mg daily for overt nephropathy, as suggested by the American Diabetes Association 5
For post-myocardial infarction patients, valsartan or candesartan are preferred ARBs, with proven mortality reduction, as recommended by the European Society of Cardiology 2

The American College of Cardiology recommends avoiding the combination of ARBs with ACE inhibitors, due to increased risk of hyperkalemia and renal dysfunction without added benefit 3, 5
Pregnancy, bilateral renal artery stenosis, and combination with ACE inhibitors or direct renin inhibitors are absolute contraindications for all ARBs, as stated by the American Heart Association 2, 5

The American Diabetes Association recommends the use of ARB + thiazide-like diuretic, ARB + dihydropyridine calcium channel blocker, and ARB + thiazide + calcium channel blocker + mineralocorticoid receptor antagonist for resistant hypertension 5
The American College of Cardiology contraindicates the combination of ARB + ACE inhibitor, due to no added benefit and increased harm 3, 5