Wednesday, October 22, 2014
Monday, December 15, 2008 dsj, Community Member, asks

Q: What is the difference between ARB's and ACE inhibitors?

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Answers (2)
Lisa Nelson, Health Pro
12/17/08 3:02pm

Hi dsj,


ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors) act within the kidney's. The kidney's produce renin. Renin is converted to angiotensis-I on into angiotensis-II. Angiotensin-II is a powerful vasoconstrictor (causes your blood vessel diameter to be smaller). Angiotensin-II also secretes aldosterone, which holds water and sodium in the kidneys instead of excreting them. This leads to increased blood volume and high blood pressure. ACE Inhibitors prevent the conversion of angiotensin-I to angiotensin-II.

ARB's (Angiotensin II Receptor Blockers) also work within the kidney. ARB's prevent angiotensin-II from binding to its' receptor site, preventing blood vessel constriction and the secretion of aldosterone.


ARB's are a newer class of high blood pressure medication and tend to be better tolerated. However, it's best to work with your MD to determine the appropriate medication for your treatment.


All the best,


Lisa Nelson, RD, LN
Diet to Lower High Blood Pressure


mamastumpy, Community Member
8/ 2/09 9:22pm

Thank you for your straight forward answer to this question, it really helped.  Can you tell me why the ACE causes a cough that I don't have on the ARB?

Lisa Nelson, Health Pro
8/ 3/09 10:58am

I'm not able to tell you why you develop a cough with one medication and not the other.  A pharmacist or your physician may have an idea as to why.


All the best,

Lisa Nelson RD

brooklynpharmD, Community Member
10/31/09 12:01am

The ACe Inhibitor inhibits angiotensinI from becoming agiotensinII. AngiotensinI causes a breakdown of a hormone called bradykinin. A buildup of Bradykinin causes a cough reflex. ARB do not cause this reaction because they work lower in the chain, it does not prevent the conversion of angiotensinI from becoming II, so angiotensinI can still break down break down bradykinin. That is the only difference between the two, any patient who has the cough needs to be switched to an ARB, otherwise an ACEI is sufficient



C.B. PharmD.


Side Efffect Fear, Community Member
11/24/09 9:36pm

I have recently been prescribed Lisinopril. I am definitley scared of having a stroke or heart attack but I am equally scared to death of one of the side effects of the medicine.....swelling and closing of the throat....I don't live near a hospital and this would surely be fatal. I know it is rare but is there any other information on this side effect that could help me to get my meds down. I understand that anaphalaxis is more likely during or after exercise.

angellique, Community Member
11/ 1/10 12:13pm

thank you for the straight forward answer.  Recently retired, my insurance refused to pay for my ARB drug until I had tried an ACE drug.  After 9 days on the drug, i was so dizzy and tired i couldn't walk without holding onto something.  Stopped the med. (liniprol HCTZ) and two days later am a bit steadier.  Can the ACE inhibitor do that?  The ARB (diovan Hct) I had been taking for 8 years and having no problem.

learnrightteachright, Community Member
4/24/13 8:27am

Hi lisa! Its wrong to state as above that renin is converted angiotensinI and angiotensin II. Renin helps convert angiotensinogen(from liver) to angiotensinI . AngI to angII is with the help of ACE. Pl correct your statements. Tnx

Linda Matuskey, RN, Community Member
9/ 2/09 4:13pm

Perhaps I can help a little...ACEI work elsewhere in the body besides the kidneys, and in the lungs it is believed that the ACEI family of drugs prevent the breakdown of certain chemicals which can result in coughing. It is also possible that this results in a proinflammatory response. Most of the time, when the ACEI medication is withdrawn, the cough symptoms subside.

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By dsj, Community Member— Last Modified: 06/03/14, First Published: 12/15/08