Clinical use of angiotensin-converting enzyme inhibitors in patients with renal impairment.
Angiotensin-converting enzyme (ACE) inhibitors are effective antihypertensive agents in a variety of patient groups, including those with chronic renal disease. In addition to their antihypertensive efficacy, there is recent evidence suggesting that ACE inhibitors may have renoprotective properties, particularly in cases of diabetic nephropathy wherein the glomerular filtration rate may be better preserved by ACE inhibitors than by other antihypertensive drugs. Although the potential benefits of ACE inhibitors are recognized, many physicians are concerned about their possible harmful effects in patients with renal disease as most ACE inhibitors are eliminated by the kidney; there is a perceived risk of progressive drug accumulation leading to toxic effects. Whether or not ACE inhibitors have a unique renoprotective effect remains to be clearly established by further long-term clinical studies. Nevertheless, in patients with hypertension and renal impairment (with the particular exception of renovascular disease), ACE inhibitors have an established efficacy and safety. If there is concern over drug accumulation in patients with impaired renal function, those ACE inhibitors (such as spirapril) with dual routes of elimination would then appear to be the agents of choice.
Elliott
H L
HL
Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, Scotland, UK.
D000375:Aging; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy*
D000806:Angiotensin-Converting Enzyme Inhibitors