Case of angioedema in man, 60, linked to losartan for blood pressure
Only a few cases reported, but awareness is 'vital,' researchers say
A 60-year-old man developed sudden angioedema as a result of losartan, a medication commonly used to treat high blood pressure, a U.S. case study reported.
Losartan, sold under the brand name Cozaar, is often used to manage cardiovascular diseases and high blood pressure. To date, only a few cases of angioedema have been associated with this medication.
But researchers say clinicians must know of losartan’s potential side effects.
“It is vital for physicians to be aware of this rare phenomenon and to stop the medication in patients who develop angioedema,” the team wrote.
The study, “A Case Report of Losartan Induced Angioedema,” was published in the journal Cureus.
Angioedema can be a side effect of blood pressure meds like Losartan
Angioedema is characterized by swelling in the deeper layers of the skin, which may also affect the membranes lining the respiratory and gastrointestinal systems.
It may occur as a side effect of certain medications, including angiotensin-converting-enzyme inhibitors (ACEIs), which account for 25%-50% of all cases of medication-related angioedema.
These medicines, often used to treat high blood pressure, work by increasing the levels of bradykinin, a molecule that prompts blood vessels to widen and blood pressure to drop. But bradykinin also may increase blood vessel permeability, causing fluid to leak out and pool in nearby tissues, resulting in swelling.
A few cases of angioedema have also been associated with angiotensin receptor blockers, or ARBs, another class of blood pressure lowering medications that also includes losartan.
In this report, researchers from East Tennessee State University described the case of a man who developed angioedema associated with losartan after he developed acute kidney disease. His medical history included treatment-resistant high blood pressure, which was being managed with several medications, including losartan.
After developing swelling in the face, lips, and tongue that had been worsening for the past day, the man was admitted at an emergency department.
At the initial presentation, he had high blood pressure, progressively increasing breathing difficulties, and noisy sounds when breathing. His face, lips, and tongue were swelling, but he had no signs of any raised, itchy rash — known as urticaria — and was not wheezing. Laboratory tests found signs of kidney disease.
The man was given epinephrine, antihistamine, and anti-inflammatory medications to reduce swelling. However, these medications failed to ease his symptoms.
At that point, he was intubated to protect his airways. At the same time, all blood pressure lowering medications he was on, including losartan, were suspended. Two days later, swelling had significantly eased and he was successfully taken off ventilation.
Close monitoring is required whenever patients present with the symptoms, as this rare phenomenon can progress to respiratory failure and lead to death.
Upon further inquiry, the patient noted that he had been diagnosed two months earlier with rapidly progressive glomerulonephritis — a condition that causes kidney function to rapidly decline over a very short period of time if untreated. His nephrologist prescribed prednisone, a corticosteroid, to treat this condition.
The patient also stated he had not taken any ACEI, and that the losartan dose he was previously on had not been recently increased. He also had no previous personal or family history of similar events.
At discharge, his swelling resolved completely, and he was instructed not to take losartan or other ARBs, or ACEIs.
“This case report shows that losartan and other angiotensin-receptor blockers should be used cautiously as a substitute for angiotensin-converting enzyme inhibitors,” the researchers wrote.
“Patients should be aware of this rare side effect,” they noted, adding, “Close monitoring is required whenever patients present with the symptoms, as this rare phenomenon can progress to respiratory failure and lead to death.”
About the Author
