Moderate renal insufficiency (serum creatinine 50 ml/min: 75-100% of the normal doseĬrCl 31-60ml/min: start 2.5 mg/da圜rCl 15-30ml/min: start 2.5 mg alternate daysĬrCl 31-60ml/min: start 2.5 mg/da圜rCl 15-30ml/min: start 2.ACE inhibitors/ARBs are not contraindicated, but should be used with caution for:.Renovascular hypertension (bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney).Contra-indications for ACE inhibitors/ARBs.Diabetes mellitus and diabetic nephropathy.Secondary prevention of coronary artery disease.Heart failure or asymptomatic left ventricular dysfunction.Hypertension (HTN), alone or in combination with diuretic or calcium-channel blocker.As ARBs are more expensive and have not shown any additional clinical benefits over ACE inhibitors, they are usually considered as an alternative for ACE inhibitors intolerant patients.ĪCE inhibitors and ARBs share most indications and contraindications: ACE inhibitors are the most used and studied type of RAAS blocker and their benefits are due to their neurohormonal modulatory effects, which have vasodilatory, anti-inflammatory, plaque-stabilizing, antithrombotic and anti-proliferative effects.ĪRBs have similar pharmacological properties to ACE inhibitors but may be better tolerated as coughing is not a frequent adverse effect. People with significant kidney damage may not be suited to take ACE inhibitors because the medication can increase blood potassium to dangerous. One in four people taking an ACE inhibitor develop a bothersome dry cough. The activation of the renin-angiotensin-aldosterone system (RAAS) plays a key role in the development and progression of cardiovascular disease, especially in arterial hypertension, heart failure and coronary artery disease. Like all medications, ACE inhibitors can cause side effects and are not appropriate for all people with high blood pressure.
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