ANGIOTENSIN RECEPTOR BLOCKERS - CARDIORENAL IMPLICATIONS IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

Congestive heart failure patients present the physician with special c onsiderations, not the least of which is an increased risk of renal fa ilure. There is great concern among practicing physicians that some an tihypertensive agents may cause the development of renal failure or ex acerbate existing renal dysfunction in these patients. Dr. Sica explai ns the renal effects of angiotensin II accumulation and the eliminatio n of angiotensin II effect in the setting of concomitant heart failure , and points out how activity of the renin-angiotensin system may diff er in these patients. The availability of angiotensin receptor antagon ists has been met with hope that these new drugs would not have the sa me renal effects in congest ive heart failure patients as have been ob served with angiotensin converting enzyme inhibitor treatment. Experim ental models have offered the theory that the angiotensin receptor ant agonists have a different, and lessened, impact on glomerular filtrati on rate. Clinical data on angiotensin receptor antagonists is just sta rting to emerge and so far, it appears that these drugs have the advan tage of not accumulating systemically, with repetitive dosing which ma y be extremely beneficial in limiting the adverse renal effects of hea rt failure treatment.