ACE inhibitors helpful in heart and kidney disease

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ACE inhibitors, a class of drugs used to lower High Blood Pressure, also significantly improve the survival of older adults with heart failure and kidney disease, results of a new study show.

“Heart failure is a disease with poor prognosis,” explained Dr. Ali Ahmed, who led the study. “ACE inhibitors are a class of drug that improves survival in these patients.”

Many people with heart failure also have chronic kidney disease, he noted. “ACE inhibitors also protect kidneys of patients with chronic kidney disease (with or without heart failure). 

So, apparently, there is dual indication and need for use of ACE inhibitors in heart failure patients with chronic kidney disease.”

However, Ahmed said, “Unfortunately, these patients are least likely to receive ACE inhibitors.”

He and his colleagues at the University of Alabama in Birmingham examined the impact of ACE inhibitors on the survival of 295 mostly elderly people who had been hospitalized with heart failure and rather severe chronic kidney disease.

Fifty-two of these patients had one or more condition usually considered a reason not to give ACE inhibitors, such as low blood pressure or high potassium levels, the researchers point out in the American Heart Journal.

Outcomes were “very poor” among these patients, Ahmed told Reuters Health.

Only 3 percent of the people with perceived contraindications to ACE inhibitor treatment and who were not prescribed the drugs when they left the hospital, were alive four years later. “When these patients were discharged on ACE inhibitors, cumulative survival increased 6-fold, from 3 percent to 19 percent,” Ahmed said.

In comparison, the 4-year cumulative survival for heart failure patients without chronic kidney disease and not receiving ACE inhibitors was 22 percent, which increased to 33 percent among those discharged on ACE inhibitors—“a significant, but much smaller margin of increase,” Ahmed noted.

The results “suggest that we might be withholding life-saving therapy with ACE inhibitors for heart failure patients with chronic kidney disease who might need these drug the most,” Ahmed concluded.

SOURCE: American Heart Journal, April 2005.

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