Which statement about ARBs is true?

• A. They selectively block AT1 receptors for angiotensin II, without increasing bradykinin; BP lowering is similar to ACE inhibitors but with lower risk of cough and angioedema; preferred in ACE inhibitor intolerance.
• B. They cause a strong reduction in bradykinin levels and no cough risk.
• C. They block ACE to decrease Ang II formation.
• D. They increase aldosterone production.

Answer: (B)

ARBs work by selectively blocking the AT1 receptor for angiotensin II, so the actions of Ang II in vessels and the adrenal gland are reduced. Unlike ACE inhibitors, they do not interfere with bradykinin breakdown, so bradykinin levels don’t rise. That’s why cough and angioedema are much less common with ARBs. Because they prevent Ang II from signaling at AT1 rather than lowering Ang II production, their blood pressure lowering is similar to ACE inhibitors, and they’re often preferred when ACE inhibitors cause cough or angioedema. The idea that ARBs strongly reduce bradykinin or that they block ACE is not correct, and their effect on aldosterone comes from reduced Ang II signaling rather than an increase.