A frequently asked question on rounds. A recent meta-analysis reported that approximately 9% of patients that developed angioedema with an ACEi possibly developed it with an ARB. However, only in 3% was the ARB a confirmed cause of angioedema. In my practice, if there's a pressing indication for RAS system blockade, an ARB may be used with relative caution.

https://www.ncbi.nlm.nih.gov/m/pubmed/19055203/

I think it is a judgement call. Although ARB would not block ACE and would not directly raise bradykinin, a small portion of patients with ARB can still develop angiodema. If indication for ACEI/ARB is sole for hypertension control, you may want to look for another class. If indeed, indication is for something more detrimental like post MI with low EF, you still may want to try ARB and closely watch the patient.

The risk of recurrent angioedema during AT2 treatment is no higher than when ACEi is withdrawn and not substituted by other drugs (8-9%). And also no higher than the incidence of angioedema in the general population. You can and should use AT2's to minimize the cardiovascular risk of the patient. Just advice the patient, that the angioedema might recur and always to seek medical attention if it does. The recurrences usually decreases with time. If the patient is diabetic and recieves an DPP4-inhibitor, you should consider avoiding ACEi altogether since ACEi and DPP4 both blocks the degradation of bradykinin and concomittant treatment severely increases the angioedema risk. Also consider to avoid neprilysin-inhibitors with concomittant ACEi treatment.