If a client cannot tolerate ACE inhibitors due to cough or hypotension, which alternative class can be used?

If a client cannot tolerate ACE inhibitors due to cough or hypotension, which alternative class can be used?

• A. Calcium channel blockers.
• B. Angiotensin II receptor blockers (ARBs) such as valsartan or losartan.
• C. Beta blockers.
• D. Thiazide diuretics.

Answer: (B)

When an ACE inhibitor isn’t tolerated because of cough or low blood pressure, the best substitute is an angiotensin II receptor blocker. ARBs block the same final pathway as ACE inhibitors—angiotensin II’s ability to constrict vessels and stimulate aldosterone—without increasing bradykinin. That’s why cough is less likely with ARBs, and they can lower BP and protect organs similarly to ACE inhibitors. Examples include valsartan and losartan. Other drug classes like calcium channel blockers, beta blockers, or thiazide diuretics change blood pressure through different mechanisms and don’t provide the same renin–angiotensin system blockade, so they aren’t the direct replacement when ACE inhibitors are not tolerated.

When an ACE inhibitor isn’t tolerated because of cough or low blood pressure, the best substitute is an angiotensin II receptor blocker. ARBs block the same final pathway as ACE inhibitors—angiotensin II’s ability to constrict vessels and stimulate aldosterone—without increasing bradykinin. That’s why cough is less likely with ARBs, and they can lower BP and protect organs similarly to ACE inhibitors. Examples include valsartan and losartan. Other drug classes like calcium channel blockers, beta blockers, or thiazide diuretics change blood pressure through different mechanisms and don’t provide the same renin–angiotensin system blockade, so they aren’t the direct replacement when ACE inhibitors are not tolerated.