Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 May-Jun;69(3):371-374.
doi: 10.1016/j.ihj.2016.08.007. Epub 2016 Sep 8.

Angiotensin-converting enzyme inhibitors and receptor blockers in heart failure and chronic kidney disease - Demystifying controversies

Kader Muneer  1 , Anishkumar Nair  2
Affiliations
Review

Angiotensin-converting enzyme inhibitors and receptor blockers in heart failure and chronic kidney disease - Demystifying controversies

Kader Muneer et al. Indian Heart J. 2017 May-Jun.

Abstract

In clinical setting, congestive heart failure (CHF) and chronic kidney disease (CKD) often co-exist in patients due to common underlying predisposing factors. An intricate equilibrium between the cardiovascular and renal system is maintained through rennin angiotensin-aldosterone axis and autonomic nervous system. Consequent to favorable hemodynamic modification, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocking (ARB) therapy have proven to be an indispensable aspect of heart failure management with morbidity and mortality benefit. Additionally, progression to end stage renal failure may be halted by renin angiotensin aldosterone system (RAAS) blockade in patients with preexisting renal dysfunction. However, concern over the safety of RAAS blockade in presence of renal impairment has led to profound underutilization of these drugs in CHF patients with renal insufficiency. This review aims to provide a simplified guide to pathophysiology and management options of this perplexing situation.

Keywords: ACE inhibitors; Angiotensin receptor blockers; Chronic kidney disease; Congestive heart failure; Creatinine.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Pathophysiologic pathways of RAAS interaction between heart failure and renal dysfunction. CHF – congestive heart failure, CKD – chronic kidney disease, RAAS – renin angiotensin aldosterone system, ACEI – angiotensin converting enzyme inhibitors, ARB – angiotensin receptor blocker, PAI-1 – plasminogen activator inhibitor-1, CVP – central venous pressure.
See this image and copyright information in PMC

References

    1. Sarnak M. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circulation. 2003;108(17):2154–2169. - PubMed
    1. Davies M.K., Gibbs C.R., Lip G.Y.H. Management: diuretics, ACE inhibitors, and nitrates. BMJ. 2000;320(7232):428–431. - PMC - PubMed
    1. Damman K., Tang W., Felker G. Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency. J Am Coll Cardiol. 2014;63(9):853–871. - PubMed
    1. Khalifeh N., Vychytil A., Hörl W. The role of peritoneal dialysis in the management of treatment-resistant congestive heart failure: a European perspective. Kidney Int. 2006;70:S72–S75. - PubMed
    1. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60(5):850–886. - PubMed

MeSH terms

Substances