ACE-INHIBITORS IN TREATMENT OF CONCOMITANT HEART AND RENAL-FAILURE

Renal function in 31 patients with mild to moderate heart failure (NYH A Classes II-III) was studied before and during treatment with ACE-inh ibitors. Maximal treatment doses were based on randomization: captopri l 3 x 12.5 mg or lisinopril or enalapril, both 1 x 10 mg. Before thera py and at the end of titration phase (after 6 days) glomerular filtrat ion rate and renal blood flow were determined from inulin and PAH clea rance (steady-state method). In the total study group the median arter ial pressure significantly decreased from 94 mmHg to 84 mmHg (p < 0.01 ), whereas glomerular filtration rate was only moderately, however, si gnificantly reduced from 103 ml/min to 97 ml/min (median values, p < 0 .01). Renal blood flow, however, increased from 372 ml/min to 403 ml/m in (p < 0.01). Changes in glomerular filtration rate (GFR(d)) were sig nificantly dependent on those of renal blood flow (GFR(d) = 0.07 RPF(d ) - 9.2; p < 0.05). All three ACE-inhibitors showed similar changes in glomerular filtration rate and renal blood flow. Ten of the patients had additionally received cyclooxygenase inhibitors. With respect to s everity of heart failure and renal function these patients did not dif fer from the remaining 21 patients of the group. In both groups, a dec rease of glomerular filtration rate was found, however, in those patie nts who had received acetylsalicylic acid there was no increase of ren al blood flow. Conclusion: A small, however significant decrease of gl omerular filtration rate is already seen in patients with mild to mode rate heart failure treated with ACE-inhibitors. Increase of renal bloo d flow counteracts the decrease of glomerular filtration rate. During concomitant application of acetylsalicylic acid the increase of renal blood flow remains absent.