Functional Renal Insufficiency During Long-Term Therapy with Captopril and Enalapril in Severe Chronic Heart Failure
- 1 March 1987
- journal article
- research article
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 106 (3), 346-354
- https://doi.org/10.7326/0003-4819-106-3-346
Abstract
Renal function was evaluated in 104 patients with severe chronic heart failure whom we treated with captopril or enalapril. Seventy patients showed no change or an improvement in renal function (group A), and 34 patients developed functional renal insufficiency (group B). Before converting-enzyme inhibition, group B patients received higher doses of furosemide (p < 0.02) and had lower central venous pressures (p < 0.05) than group A patients. After 1 to 3 months of converting-enzyme inhibition, an excessive reduction in left ventricular filling pressure (to less than 15 mm Hg) or mean arterial pressure (to less than 60 mm Hg) was noted in 28 of 34 (82%) patients in group B but in only 22 of 70 patients in group A (31%) (p < 0.001). At the end of the study, drug-induced azotemia resolved after a reduction in the dosage of diuretics, despite unaltered treatment with captopril and enalapril. Hence, the deterioration of renal function after converting-enzyme inhibition in heart failure is not a toxic or immunologic reaction to therapy but results from specific hemodynamic events that can be ameliorated by sodium repletion.Keywords
This publication has 10 references indexed in Scilit:
- Preservation of glomerular filtration rate in human heart failure by activation of the renin-angiotensin system.Circulation, 1986
- Sodium and water balance in chronic congestive heart failure.JCI Insight, 1986
- Influence of Renal Function on the Hemodynamic and Clinical Responses to Long-Term Captopril Therapy in Severe Chronic Heart FailureAnnals of Internal Medicine, 1986
- Captopril-Induced Renal Insufficiency and the Role of Sodium BalanceAnnals of Internal Medicine, 1985
- Effects of captopril on arterial and venous pressure, renal function, and humoral factors in severe chronic congestive heart failureClinical Pharmacology & Therapeutics, 1984
- Correction of Dilutional Hyponatremia in Severe Chronic Heart Failure by Converting-Enzyme InhibitionAnnals of Internal Medicine, 1984
- Renal Response to Captopril in Severe Heart Failure: Role of Furosemide in Natriuresis and Reversal of HyponatremiaAnnals of Internal Medicine, 1984
- Potassium homeostasis in chronic experimental diabetes mellitus in ratsActa Endocrinologica, 1984
- Controlled trial of captopril in chronic heart failure: a rest and exercise hemodynamic study.Circulation, 1983
- Blood pressure and renal function during chronic changes in sodium intake: role of angiotensinAmerican Journal of Physiology-Renal Physiology, 1980