Renal effects of angiotensin-converting enzyme inhibition therapy in the treatment of inhibition in congestive heart failure

Congestive heart failure (CHF) is a condition in which the left side of the heart is unable to pump sufficient blood to supply oxygen and nutrients to the body. This is partially attributable to insufficiency of the left ventricle (the chamber of the heart from which blood is pumped to all portions of the body except the lungs) resulting from excessively high vascular resistance. An accepted treatment strategy for decreasing vascular resistance is to administer drugs that cause the blood vessels to relax. Angiotensin-converting enzyme inhibition therapy in the treatment of (ACE) inhibitors are one type of drug used for this purpose. It has been reported that kidney function, which is often compromised in patients with CHF, is also affected by treatment with ACE inhibitors. However, the nature of the change is controversial. In some patients, a dramatic improvement in kidney function is observed; in others, just as precipitous a decline is seen. ACE treatment alters a number of physiological factors influencing the kidney, including blood flow, glomerular perfusion pressure, and others; some of these alterations tend to improve kidney function, other are detrimental. In most patients, the detrimental effects of ACE inhibition are compensated for by other mechanisms, allowing the positive effects (such as improved blood flow) to manifest themselves. In some cases, concurrent therapy for CHF such as blood volume reduction induced by diuretics, or administration of prostaglandin inhibitors, can limit the effectiveness of the compensatory mechanisms; in these cases deterioration of kidney function is seen. (Consumer Summary produced by Reliance Medical Information, Inc.)