Functional renal insufficiency during long-term therapy with captopril and enalapril in severe chronic heart failure

M. Packer, W. H. Lee, N. Medina, M. Yushak, P. D. Kessler

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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.

Original languageEnglish (US)
Pages (from-to)346-354
Number of pages9
JournalAnnals of Internal Medicine
Volume106
Issue number3
StatePublished - 1987

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Enalapril
Captopril
Renal Insufficiency
Heart Failure
Kidney
Therapeutics
Enzymes
Azotemia
Central Venous Pressure
Poisons
Furosemide
Ventricular Pressure
Diuretics
Arterial Pressure
Hemodynamics
Sodium
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Functional renal insufficiency during long-term therapy with captopril and enalapril in severe chronic heart failure. / Packer, M.; Lee, W. H.; Medina, N.; Yushak, M.; Kessler, P. D.

In: Annals of Internal Medicine, Vol. 106, No. 3, 1987, p. 346-354.

Research output: Contribution to journalArticle

Packer, M, Lee, WH, Medina, N, Yushak, M & Kessler, PD 1987, 'Functional renal insufficiency during long-term therapy with captopril and enalapril in severe chronic heart failure', Annals of Internal Medicine, vol. 106, no. 3, pp. 346-354.
Packer, M. ; Lee, W. H. ; Medina, N. ; Yushak, M. ; Kessler, P. D. / Functional renal insufficiency during long-term therapy with captopril and enalapril in severe chronic heart failure. In: Annals of Internal Medicine. 1987 ; Vol. 106, No. 3. pp. 346-354.
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