Which ARB is Less Likely to Cause Palpitations?
Based on FDA labeling data, losartan reports palpitations as an adverse event, while the available evidence does not distinguish between ARBs in terms of palpitation risk—all ARBs as a class demonstrate a side effect profile comparable to placebo in most studies. 1, 2
ARB Class Safety Profile
The available evidence indicates that ARBs as a class have favorable tolerability:
ARBs demonstrate significantly fewer side effects than ACE inhibitors, with a side effect profile comparable to placebo in the majority of studies conducted primarily in hypertension. 2, 3
The European Society of Cardiology notes that ARBs are generally well-tolerated with adverse effects significantly less common than with ACE inhibitors, particularly regarding cough. 2
Losartan-Specific Adverse Event Data
The FDA label for losartan provides the most specific data on palpitations:
Palpitations are listed as a less common adverse reaction (occurring in <2% of patients) in losartan clinical trials involving over 3,300 patients treated for essential hypertension. 1
Other cardiac adverse events reported with losartan include syncope and atrial fibrillation, though these were also uncommon. 1
The overall incidence of adverse events with losartan was similar to placebo, with discontinuation rates of 2.3% for losartan versus 3.7% for placebo. 1
Comparative ARB Data
Recent network meta-analysis provides comparative safety data across ARBs:
Olmesartan ranked highest in safety (70.8%) among six commonly used ARBs (losartan, valsartan, irbesartan, telmisartan, candesartan, olmesartan) in a 2024 network meta-analysis of 193 studies. 4
Olmesartan and telmisartan were associated with fewer adverse events than losartan, though the incidence of adverse events was similar between other ARBs. 4
Valsartan and losartan were less effective in lowering blood pressure than other ARBs with no significant safety advantages. 4
Clinical Implications
If palpitations are a concern, consider olmesartan or telmisartan as they demonstrated the best balance of efficacy and minimal adverse events in the most recent comparative analysis. 4
All ARBs should be monitored for standard adverse effects including hypotension, renal function changes, and hyperkalemia rather than specific cardiac symptoms like palpitations. 3
The European Society of Cardiology recommends standard monitoring should focus on blood pressure, renal function, and potassium levels when prescribing any ARB. 3
Important Caveats
No head-to-head trials specifically compare palpitation rates between different ARBs, so recommendations are based on overall adverse event profiles rather than palpitation-specific data. 4
Individual patient factors including comorbidities (heart failure, post-MI status, atrial fibrillation history) may influence ARB selection more than palpitation risk alone. 2
If palpitations occur with one ARB, switching to another ARB (particularly olmesartan or telmisartan based on safety rankings) is reasonable before abandoning the class entirely. 4