Which factor would favor choosing an ARB over an ACE inhibitor in heart failure management?

• A. ARBs have fewer adverse effects related to cough or angioedema compared with ACE inhibitors
• B. ACE inhibitors are never first-line
• C. ARBs are first-line and ACE inhibitors are avoided
• D. ARBs are never used with beta-blockers

Answer: (A)

In heart failure management, the factor that favors an ARB over an ACE inhibitor is tolerability related to cough and angioedema. ACE inhibitors can cause a dry cough and, less commonly, angioedema because they increase bradykinin levels. ARBs block the angiotensin II receptor without affecting bradykinin, so the risk of these adverse effects is much lower. If a patient experiences cough or has a history of angioedema with an ACE inhibitor, switching to an ARB preserves the beneficial RAAS blockade with better tolerability. Both drug classes provide similar benefits in heart failure and can be used alongside beta-blockers. The other statements aren’t accurate because ACE inhibitors are commonly first-line, ARBs are not categorically first-line, and ARBs can be used with beta-blockers.