From the Guidelines
Angiotensin receptor blockers (ARBs) can be safely used in patients with inflammatory bowel disease (IBD) such as ulcerative colitis, without exacerbating bowel symptoms. The medical management of nonhospitalized ulcerative colitis, as outlined in the Toronto consensus guidelines 1, does not specifically address the use of ARBs in patients with IBD. However, based on the mechanism of action of ARBs, which block the angiotensin II type 1 receptor without affecting bradykinin metabolism, it is reasonable to conclude that they do not negatively impact intestinal inflammation. Some key points to consider when using ARBs in patients with IBD include:
- Standard dosing applies, such as losartan 25-100 mg daily, valsartan 80-320 mg daily, or candesartan 8-32 mg daily
- Dose adjustments should be based on blood pressure response and kidney function
- Regular monitoring of blood pressure, kidney function, and potassium levels remains important, as with any patient on ARB therapy
- ARBs represent a safe option for IBD patients with hypertension, heart failure, diabetic nephropathy, or other indications for ARB therapy, without worsening their gastrointestinal condition 1.
From the Research
ARB Medication and Bowel Disease
- The relationship between Angiotensin II Receptor Blockers (ARB) and bowel disease has been explored in several studies 2, 3.
- A study published in 2019 found that IBD patients taking an ACEI or ARB had fewer hospitalizations, operations, and corticosteroid prescriptions compared to matched controls 2.
- However, the same study found that patients with ulcerative colitis (UC) had increased hospitalizations and decreased corticosteroid use during ACEI/ARB exposure 2.
- Another study published in 2022 found that the risk of diarrhea, a common adverse drug reaction, differs between different ARB medications, with eprosartan and telmisartan being significantly associated with diarrhea 3.
Treatment Approaches to Inflammatory Bowel Disease
- The treatment approach to inflammatory bowel disease (IBD) involves identifying the appropriate patients for new medications with novel mechanisms of action and using a treat-to-target algorithm to improve clinical outcomes 4.
- A study published in 2012 summarized the current guidelines for first-line treatments in IBD, including 5-aminosalicylates, budesonide, systemic steroids, azathioprine, and biologics such as infliximab and adalimumab 5.
- However, ARB medications are not typically considered first-line treatments for IBD, but rather are used to treat hypertension and other cardiovascular conditions 6.
Comparison of ARB Medications
- A study published in 1999 compared the antihypertensive effects of six different ARB medications, including losartan, valsartan, and irbesartan, and found that they were all effective in treating mild, moderate, and severe hypertension 6.
- The 2022 study found that the risk of diarrhea varies between different ARB medications, suggesting that some ARBs may be more suitable for patients with bowel disease than others 3.