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Ace inhibitor therapy for heart failure in patients with impaired renal function: a review of the literature

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Abstract

Heart failure syndromes are often associated with multi-organ dysfunction, and concomitant liver, renal, and neurologic involvement is very common. Neuro-hormonal antagonism plays a key role in the management of this syndrome, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are one of the cornerstones of therapy. Cardiorenal physiology is becoming more recognized in these patients with advanced heart failure, and the role of neuro-hormonal blockade in this setting is vaguely defined in the literature. Often, angiotensin-converting enzyme inhibitors are decreased or even withheld in these circumstances. The purpose of this article is to review the role and pathophysiology of ace inhibition and angiotensin receptor blockade in patients with acute and chronic heart failure syndromes and concomitant cardiorenal physiology.

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Acknowledgments

The authors would like to acknowledge Dr. Giuseppe Remuzzi for his insight and advice into this review. His comments were deservedly appreciated.

Conflict of interest

Dr. Mihai Gheorghiade has the following disclosures and conflicts of interest: Abbott Laboratories, Astellas, AstraZeneca, Bayer Schering Pharma AG, CorThera, Cytokinetics, DebioPharm S.A., Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Johnson & Johnson, Medtronic, Merck, Novartis Pharma AG, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, Sanofi-Aventis, Sigma Tau, Solvay Pharmaceuticals, and Trevena Therapeutics; and has received signficant (>$10,000) support from Bayer Schering Pharma AG, DebioPharm S.A., Medtronic,Novartis Pharma AG, Otsuka Pharmaceuticals, Sigma Tau, Solvay Pharmaceuticals, and Pericor Therapeutics. Dr. Ali Valika has no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Cardiology, Northwestern University Feinberg School of Medicine, 675 N. St. Clair, Galter Pavilion, Suite#11-120, Chicago, IL, 60601, USA

    Ali A. Valika

  2. Northwestern University Feinberg School of Medicine, 645 North Michigan Ave. Suite 1006, Chicago, IL, 60601, USA

    Mihai Gheorghiade

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  1. Ali A. Valika
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  2. Mihai Gheorghiade
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Correspondence to Ali A. Valika.

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Valika, A.A., Gheorghiade, M. Ace inhibitor therapy for heart failure in patients with impaired renal function: a review of the literature. Heart Fail Rev 18, 135–140 (2013). https://doi.org/10.1007/s10741-011-9295-6

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  • DOI: https://doi.org/10.1007/s10741-011-9295-6

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