Which statement best describes the risk of angioedema with ARBs compared with ACE inhibitors?

• A. ARBs have a higher risk of angioedema than ACE inhibitors.
• B. ARBs have a lower risk of angioedema and typically do not cause cough.
• C. ARBs and ACE inhibitors have the same risk for angioedema.
• D. ARBs cause angioedema only in combination with diuretics.

Answer: (B)

The main idea is understanding why ARBs have a much lower risk of angioedema than ACE inhibitors due to their different effects on bradykinin. ACE inhibitors raise bradykinin levels by blocking its breakdown, which can lead to cough and angioedema in susceptible people. ARBs, by blocking the angiotensin II receptor rather than affecting bradykinin, don’t typically raise bradykinin and therefore usually don’t cause cough and have a lower risk of angioedema. Rare cases of angioedema can still occur with ARBs, but the incidence is much lower than with ACE inhibitors. The other statements aren’t correct: ARBs do not have a higher risk, they do not share the same risk level, and angioedema with ARBs isn’t limited to use with diuretics.