Angiotensin-Converting Enzyme Inhibitors

Rotmensch, Heschi H.; Vlasses, Peter H.; Ferguson, Roger K.

doi:10.1016/s0025-7125(16)30776-3

Cited by 32 publications

(3 citation statements)

References 195 publications

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“…2 Many published reviews are of captopril, enalapril, and lisinopril. [7][8][9][10][11][12][13][14][15] In spite of all these reviews, none of them has focused on the problem of whether one or another ACE-I is suitable for the patient with renal disease. Each of the ACE-Is is different in terms of chemical group, molecular weight, the prodrug, lipid solubility, the organ via which it is eliminated and the protein binding rate.…”

Section: Introductionsupporting

confidence: 80%

Comparison of the renal effects of different angiotensin-converting enzyme inhibitors in patients with chronic renal diseases

Kaizu

Sun

Uriu

et al. 2002

Clinical and Experimental Nephrology

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Section: Introductionsupporting

confidence: 80%

Comparison of the renal effects of different angiotensin-converting enzyme inhibitors in patients with chronic renal diseases

Kaizu

Sun

Uriu

et al. 2002

Clinical and Experimental Nephrology

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“…These patients probably should not receive ACE inhibitors. For reasons not completely understood, patients with collagen-vascular disease have an increased frequency of side effects of ACE inhibitors (Rotmensch et al 1988); these patients should probably not receive the drugs.…”

Section: High-risk Groupsmentioning

confidence: 99%

Adverse Effects of Angiotensin Converting Enzyme (ACE) Inhibitors

Parish

Miller

1992

Drug Safety

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The angiotensin converting enzyme (ACE) inhibitors are a group of effective drugs with a unique mechanism of action. These drugs have proven to be useful for hypertension and congestive heart failure. Early clinical trials of captopril used doses that are now known to be inappropriately high, and dose-related adverse effects were observed frequently. The recognition that lower doses are effective has reduced the incidence of adverse reactions and resulted in improved patient tolerance. When patients are properly selected and correctable risk factors are removed, serious side effects are uncommon. Unfortunately, the early reputation of nephrotoxicity persists, as does the belief that significant blood dyscrasias, endocrine effects and rash are serious risks for the average patient. After wide use of captopril, enalapril and lisinopril, and investigational trials of nearly a dozen newer agents, a sufficiency of clinical observation, experimental evidence and accurate postmarketing recording of events is accumulating to allow insight into the major toxicities with regard to more intelligent patient selection, more rational dosing and proper identification of risk factors. The most common adverse reactions are cough and skin rash. It appears that the agents are generally not cross-reactive with regard to skin rash, although it is not clear whether this effect is drug-specific or class-specific with regard to cough. Statistically but not clinically significant lowering of haemoglobin and hematocrit is common; these effects are inconsequential in most patients. Neutropenia, once thought to be prevalent, now appears to be so only in patients with autoimmune or collagen-vascular disease; the majority of patients outside these groups are at low risk. Hyperkalaemia is a frequent occurrence. This should not be surprising in view of the effect of the ACE inhibitors on plasma aldosterone. When dietary potassium intake is regulated and sources of altered potassium excretion are identified, hyperkalaemia is seldom a serious problem. Identification of sodium and water deficits allows correction before the drugs are started, and the frequency of hypotension and hyperkalaemia caused by the drugs is quite low if these factors are properly managed. An unexpected finding emerging in recent years is the dry cough associated with ACE inhibitor therapy. Its mechanism is not definitely known. Nonsteroidal anti-inflammatory drugs may control this symptom in some patients. The frequent observation of proteinuria in patients taking ACE inhibitors has gained notice and sometimes caused undue alarm. It is difficult to separate disease effects in diabetes and hypertension from true drug effects.(ABSTRACT TRUNCATED AT 400 WORDS)

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“…4 It is unlikely that recommendations for a given amount of sodium and potassium restriction, fluid intake, ACE inhibition, or diuretic schedule can be universally applied to all dogs with CHF. This emphasizes the need to monitor each patient closely by evaluating arterial blood pressure, serum electrolyte concentrations, and renal function during combined therapy with sodiumrestricted diets, diuretics, and ACE inhibitors.…”

mentioning

confidence: 99%

The Effect of Combined Therapy With Captopril, Furosemide, and a Sodium‐Restricted Diet on Serum Electrolyte Concentrations and Renal Function in Normal Dogs and Dogs With Congestive Heart Failure

Roudebush

Allen²,

Kuehn³

et al. 1994

Veterinary Internal Medicne

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Captopril, furosemide, and a sodium-restricted diet were administered t o 6 normal dogs and 10 dogs with congestive heart failure. Serum electrolyte concentrations and renal function were monitored in both groups. In the normal dogs, no clinically meaningful changes in serum electrolyte, urea nitrogen, or creatinine concentrations developed during therapy with a sodium-restricted diet and 4 weeks each of furosemide alone, captopril alone, or furosemide plus captopril. Three of 6 normal dogs on furosemide and a sodium-restricted diet had at least one serum potassium concentration above the reference range during the 4 weeks of observation. One normal dog on captopril, furosemide. and a sodium-restricted diet developed azotemia, and 2 dogs had serum potassium concentrations above the reference range during the 4 weeks of observation. Ten dogs with congestive heart failure were treated with captopril, furosemide, a sodium-restricted diet, and digoxin.herapy for congestive heart failure (CHF) often in-T cludes the use of diuretics and sodium restriction to reduce preload and venous congestion; cardiac glycosides to increase contractility and control supraventricular arrhythmias; and vasodilators to reduce venous congestion, preload, and afterload. Captopril, an inhibitor of angiotensin converting enzyme (ACE), is a popular vasodilator used to treat dogs with CHF. This drug inhibits the formation of angiotensin I1 and results in vasodilation and decreased circulating plasma aldosterone concentrations.' Aldosterone plays an important role in the maintenance of vascular volume and potassium balance via its effects on the renal cortical collecting tubule cell. It also increase the reabsorption of sodium and chloride and promotes the secretion of potassium. The use of ACE inhibitors in human patients with severe renal insufficiency or in those given potassium supplements may increase the risk for h~perkalemia.~.~ It is not known whether the levels of potassium in popular pet foods or sodium-restricted diets will increase the risk for hyperkalemia in dogs receiving ACE inhibitors such as captopril.Functional renal insufficiency has been documented in up to one third of salt-restricted human patients with severe CHF treated with ACE inhibitors and diuretic^.^ This decline in renal function has been attributed to loss of angiotensin Ii-mediated systemic and intrarenal vasoconstrictor effects that maintain renal perfusion pressure and glomerular filtration rate in low output heart failure. Functional renal insufficiency appeared to be alleviated when efforts were made to replenish total body stores of sodium by reducing the diuretic dose and liberalizing dietary sodium intake.' Renal insufficiency is a complication of captopril therapy in dogs with CHF, but the role of sodium restriction is unknown.6 The purpose of this report is to describe the electrolyte concentrations and renal function in both normal dogs and dogs with CHF receiving captopril, furosemide, and a sodium-restricted diet.Etiopathogenesis of the heart failur...

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Angiotensin-Converting Enzyme Inhibitors

Cited by 32 publications

References 195 publications

Comparison of the renal effects of different angiotensin-converting enzyme inhibitors in patients with chronic renal diseases

Comparison of the renal effects of different angiotensin-converting enzyme inhibitors in patients with chronic renal diseases

Adverse Effects of Angiotensin Converting Enzyme (ACE) Inhibitors

The Effect of Combined Therapy With Captopril, Furosemide, and a Sodium‐Restricted Diet on Serum Electrolyte Concentrations and Renal Function in Normal Dogs and Dogs With Congestive Heart Failure

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