Renal and Electrolyte Complications of Congestive Heart Failure and Effects of Therapy With Angiotensin-Converting Enzyme Inhibitors

James R. Oster, Barry J. Materson

Research output: Contribution to journalReview articlepeer-review

54 Scopus citations

Abstract

Blood pressure declines in virtually all patients with severe congestive heart failure given an angiotensin-converting enzyme (ACE) inhibitor, but hypotension is of concern only if symptomatic. Acute renal insufficiency induced by an ACE inhibitor is due to reduced renal perfusion pressure together with blockade of angiotensin II-induced constriction of the efferent arteriole. Risk factors (or markers) for renal failure include hyponatremia, hypotension, volume contraction. Hyponatremia is an index of increased hemodynamic impairment, marked activation of the renin-angiotensin-aldosterone axis, and poor prognosis. Preventive measures for both ACE inhibitor-associated hypotension and renal insufficiency include withholding diuretics for a few days, initiating therapy with very small doses of ACE inhibitors, and cautious dose titration. Therapy for both hypotension and renal insufficiency involves increasing dietary sodium intake and reducing the dosage of, or temporarily discontinuing, the diuretic. The ACE inhibitor may have to be given at reduced dosage or discontinued for a time. If discontinuation is deemed necessary, administration of these survival-prolonging medications should be reinitiated after a brief respite whenever possible.

Original languageEnglish (US)
Pages (from-to)704-710
Number of pages7
JournalArchives of internal medicine
Volume152
Issue number4
DOIs
StatePublished - Apr 1992

ASJC Scopus subject areas

  • Internal Medicine

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