Angiotensin is a short peptide hormone that causes constriction of the efferent arteriole at the glomerulus, leading to increased glomerular filtration pressure. This can maintain glomerular filtration when renal blood flow drops (low blood pressure, renal artery stenosis), but drugs may paralyse this reflex. Angiotensin also has direct effects on many other cells, including the podocyte, and it is likely that some of its effects depend on these other actions too.<\/p>\n
Excellent agents for hypertension, including in renal disease, but particularly for proteinuria-associated renal disease:<\/p>\n
Most evidence for these benefits has come from trials in which ACE inhibitors were used at maximum or near-maximum doses.<\/p>\n
1.\u00a0\u00a0 Cause a dry cough in some recipients
\n2.\u00a0\u00a0 Can cause hyperkalaemia; especially<\/p>\n
3.\u00a0\u00a0 Cause a variable drop in GFR in anyone, but can can cause a marked drop in the presence of renal artery stenosis<\/p>\n
4.\u00a0\u00a0 Predispose to acute kidney injury if patient becomes dehydrated or infected, or cardiac output or blood pressure drop.<\/p>\n
Some are effective when given once daily. Some may be less likely to cause first-dose hypotension. However most effects are shared by all drugs in the class. Captopril was the prototype, but it needs to be given two or three times daily and has some additional side effects.<\/p>\n
Angiotensin II receptor type I antagonists (ARBs)<\/span><\/strong><\/p>\n Angiotensin receptor blockers (ARBs) have similar effects and side-effects to ACE inhibitors, except that they do not cause cough. They are first-choice alternatives if ACE inhibitor-induced cough occurs, but are otherwise probably broadly comparable. ACE inhibitors and ARBs have rarely been directly compared.<\/p>\n Angiotensin is a short peptide hormone that causes constriction of the efferent arteriole at the glomerulus, leading to increased glomerular filtration pressure. This can maintain glomerular filtration when renal blood flow drops (low blood pressure, renal artery stenosis), but drugs may paralyse this reflex. Angiotensin also has direct effects on\u2026<\/p>\n
\nHow to start an ACE inhibitor or ARB<\/span><\/strong><\/h3>\n
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\nFurther info<\/span><\/strong><\/h3>\n
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