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High Blood Pressure

ARB tablets

09/29/2009

Question:

Dear doctor,

I have been considering trying out an ARB but was wondering which type is better, candesartan, losartan or olmesartan. My understanding is that olmesartan and losartan are better. I also find myself in a predicament in that after continuous use of most medication, I start getting some sort of asthma like breathing problems. I am a mild asthmatic . Are there any medications which are suitable for asthmatics and well tolerated?

Thanks.

Answer:

There is very little difference between candesartan, losartan and olmesartan.  Although they are different molecules, they work by the same mechanism and there should be no noticeable difference in their clinical effects and side effects.  Exceptions and allergic reactions are possible, but rare.

Regarding asthma, the only anti-hypertensive drugs that are contra-indicated are beta blockers. None of the other agents have an effect on bronchoconstriction.

If you have difficulty with an ARB, you may try a direct renin inhibitor (aliskiren).  Aliskiren is very well tolerated and has not been found to worsen asthma.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati