[Are AT1 receptor antagonists an alternative to ACE inhibitors in angioedema?]

History of angioedema is a contraindication for ACE-inhibitors. Angioedema is caused by: 1. a decreased degradation of bradykinin, 2. a defect in C 1-esterase-inhibitor with the increased generation of bradykinin or 3. other trigger mechanisms as food, pollen and stress. AT1 receptor antagonists do not inhibit the degradation of bradykinin. Thus angioedema is no contraindication for AT1 receptor antagonists. In patients with an anamnestic angioedema or ACE-induced angioedema AT1 receptor antagonists can be given under close monitoring provided that there is strong indication for inhibition of the renin-angiotensin system.