الفهرس Only 14 pages are availabe for public view
 |  | from | 196 |  |  |
| | | from | 196 | | |
Abstract
The degree of renal protection from ACE inhibitors and ARBs is directly related to the severity of renal impairment at baseline. It has also been shown that the magnitude of mortality reduction in patients with acute MI and CHF treated with an ACE was greater in those with renal insufficiency than without, demonstrating that CHF patients with renal insufficiency may benefit more from an ACE-inhibitor or ARB than those patients with CHF alone.
Data from the Prevention of Events with ACE inhibition (PEACE) trial, studying the use of ACE-inhibitors in patients with stable coronary disease and preserved systolic function, showed that the relation between GFR and clinical outcome is substantially modified by ACE-inhibitor therapy and that patients with a reduced GFR may be most likely to benefit from the cardiovascular protective effects of ACE-inhibitors.
Certain beta-blockers should be used cautiously in patients with reduced renal function. Some long acting beta-blockers such as atenolol and nadolol are excreted primarily by the renal route. Other beta-blockers, especially ones used in CHF management, such as metoprolol and carvedilol, are eliminated through hepatic metabolism and would not require a dosage adjustment in patients with renal insufficiency.
It can be recommend that all patients with CHF and stable renal insufficiency be given a trial of the medications shown to reduce mortality and morbidity except for the use of aldosterone antagonist (spironolactone and eplerenone). In CHF patients with renal insufficiency, initiation and titration of medications which are eliminated through renal excretion or have the potential to affect renal function probably need to be performed more slowly than in CHF patients with normal renal function.