If a patient cannot tolerate ACE inhibitors due to cough or angioedema, which class should be used?

• A. Calcium channel blockers.
• B. Beta-blockers.
• C. Diuretics.
• D. ARBs.

Answer: (D)

When ACE inhibitors are not tolerated because of cough or angioedema, an ARB is used because it blocks the same renin–angiotensin system downstream at the angiotensin II receptor without increasing bradykinin. That means the beneficial effects on afterload, preload, and remodeling are preserved, but the troublesome bradykinin-related side effects are much less likely. The other options don’t provide this specific replacement: calcium channel blockers don’t address the RAAS pathway, diuretics treat fluid overload but don’t substitute for RAAS blockade, and beta-blockers are important in heart failure management but cannot replace ACE inhibitors' mechanism.