ramipril and Renal-Artery-Obstruction

The Heart Outcomes Prevention Evaluation (HOPE) study has provided evidence for the use of ramipril for secondary cardiac prevention for patients with peripheral arterial disease. Despite this many vascular surgeons and general practitioners are reluctant to prescribe ACE inhibitors in a group of patients perceived to have a high incidence of renal artery stenosis. This review aims to review the pathophysiology of the renin-angiotensin system and make evidence based recommendations for commencing ACE inhibitors as part of a comprehensive delivery of best medical therapy to patients with peripheral arterial disease.

Topics: Algorithms; Angiotensin II; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Comorbidity; Humans; Peripheral Vascular Diseases; Ramipril; Renal Artery Obstruction; Renin-Angiotensin System

Topics: Aged, 80 and over; Angioplasty; Carbazoles; Carvedilol; Combined Modality Therapy; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Hypertension; Hypertension, Renovascular; Life Style; Propanolamines; Ramipril; Renal Artery Obstruction; Stents; Weight Loss

Topics: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Dose-Response Relationship, Drug; Female; Humans; Hypertension; Kidney Failure, Chronic; Male; Ramipril; Renal Artery Obstruction; Renal Dialysis; Time Factors

The converting enzyme inhibitor, ramipril, 20 mg once daily, was given to 3 hypertensive patients with unilateral renovascular disease. At 1 month, 24 hours after the last dose of ramipril, blood pressure, plasma angiotensin II and converting enzyme activity remained low, and active renin and angiotensin I high. There was no tendency for converting enzyme inhibition to be overcome during 1 month of ramipril therapy. Ramipril caused slight increases in serum potassium and urea, no change in serum creatinine and no consistent changes in the renal vein renin ratio. Ramipril caused little change in renal plasma flow on the stenotic side, but filtration fraction was reduced in 2 patients. There was no serious deterioration in total or individual glomerular filtration rate during ramipril therapy. The drug was well tolerated and there were no serious side effects. Ramipril, given once daily, is likely to be effective in controlling hypertension with renal artery stenosis.

Topics: Adult; Angiotensin II; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Bridged Bicyclo Compounds; Bridged-Ring Compounds; Female; Glomerular Filtration Rate; Humans; Hypertension, Renovascular; Male; Middle Aged; Potassium; Ramipril; Renal Artery Obstruction; Renin-Angiotensin System