Inhibition of the renin-angiotensin system in the cardiorenal syndrome with anaemia: a double-edged sword.

Abstract:

:: The term 'cardiorenal syndrome' (CRS) was introduced to describe problems related to the simultaneous existence of heart and renal insufficiency. The prevalence of anaemia in CRS is high and increases the risk of hospitalizations and death. Renin-angiotensin system (RAS) inhibition is the cornerstone therapy in cardiovascular and renal medicine. As angiotensin II regulates both glomerular filtration rate (GFR) and erythropoiesis, RAS inhibition can further deteriorate renal function and lower hematocrit or cause anaemia in patients with heart failure. The aim of this review is to explore the relationship among CRS, anemia and administration of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) and summarize the evidence suggesting that RAS inhibition may be considered an iatrogenic cause of deterioration of CRS with anemia. It should be emphasized however, that RAS inhibition reduces mortality in both groups with and without worsening of renal function, and therefore, no patient with CRS should be denied an ACEi or ARB trial without careful evaluation.

journal_name

J Hypertens

journal_title

Journal of hypertension

authors

Vlahakos DV,Tsioufis C,Manolis A,Filippatos G,Marathias KP,Papademetriou V,Mancia G

doi

10.1097/HJH.0000000000002111

subject

Has Abstract

pub_date

2019-11-01 00:00:00

pages

2145-2153

issue

11

eissn

0263-6352

issn

1473-5598

journal_volume

37

pub_type

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