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Titolo:
Risk-benefit ratio of angiotensin antagonists versus ACE inhibitors in end-stage renal disease
Autore:
Sica, DA; Gehr, TWB; Fernandez, A;
Indirizzi:
Virginia Commonwealth Univ, Med Coll Virginia, Div Clin Pharmacol, Richmond, VA 23298 USA Virginia Commonwealth Univ Richmond VA USA 23298 , Richmond, VA 23298 USA Virginia Commonwealth Univ, Med Coll Virginia, Div Nephrol & Hypertens, Richmond, VA 23298 USA Virginia Commonwealth Univ Richmond VA USA 23298 , Richmond, VA 23298 USA
Titolo Testata:
DRUG SAFETY
fascicolo: 5, volume: 22, anno: 2000,
pagine: 350 - 360
SICI:
0114-5916(200005)22:5<350:RROAAV>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
CONVERTING ENZYME-INHIBITORS; INTERDIALYTIC WEIGHT-GAIN; II RECEPTOR ANTAGONIST; HEMODIALYSIS-PATIENTS; ANAPHYLACTOID REACTIONS; DIALYSIS PATIENTS; BLOOD-PRESSURE; AN69 MEMBRANES; CARDIOVASCULAR-DISEASE; HYPERTENSIVE PATIENTS;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
101
Recensione:
Indirizzi per estratti:
Indirizzo: Sica, DA Virginia Commonwealth Univ, Med Coll Virginia, Div Clin Pharmacol, Box 980160,MCV Stn, Richmond, VA 23298 USA Virginia Commonwealth Univ Box980160,MCV Stn Richmond VA USA 23298
Citazione:
D.A. Sica et al., "Risk-benefit ratio of angiotensin antagonists versus ACE inhibitors in end-stage renal disease", DRUG SAFETY, 22(5), 2000, pp. 350-360

Abstract

The effective treatment of hypertension is an extremely important consideration in patients with end-stage renal disease (ESRD). Virtually any drug class with the possible exception of diuretics - can be used to treat hypertension in the patient with ESRD. Despite there being such a wide range of treatment options, drugs which interrupt the renin-angiotensin axis are generally suggested as agents of choice in this population, even though the evidence in support of their preferential use is quite scanty. ACE inhibitors, and more recently angiotensin antagonists, are the 2 drug classes most commonly employed to alter renin-angiotensin axis activity andtherefore produce blood pressure control. ACE inhibitor use in patients with ESRD can sometimes prove an exacting proposition ACE inhibitors are variably dialysed, with compounds such as catopril, enalaprill lisinopril and perindopril undergoing substantial cross-dialyser clearance during a standard dialysis session. This phenomenon makes the selection of a dose and the timing of administration for an ACE inhibitor a complex issue in patients with ESRD. Furthermore, ACE inhibitors are recognised as having a range of nonpressoreffects that are pertinent to patients with ESRD. Such effects include their ability to decrease thirst drive and to decrease erythropoiesis. In addition, ACE inhibitors have a unique adverse effect profile. As is the case with their use in patients without renal failure, use of ACE inhibitors in patients with ESRD can be accompanied by cough and less frequently by angioneurotic oedema. In the ESRD population, ACE inhibitor use is also accompanied by so-called anaphylactoid dialyser reactions. Angiotensin antagonists are similar to ACE inhibitors in their mechanism of blood pressure lowering. Angiotensin antagonists are not dialysable and therefore can be distinguished from a number of the ACE inhibitors. In addition, the adverse effect profile for angiotensin antagonists is remarkably bland, with cough and angioneurotic oedema rarely, if ever, occurring. In patients with ESRD, angiotensin antagonists are also not associated with the anaphylactoid dialyser reactions which occur with ACE inhibitors. The nonpressor effects of angiotensin antagonists - such as an influence on thirst drive and erythropoiesis - have not been explored in nearly the depth, as they have been with ACE inhibitors. Although ACE inhibitors have not been compared directly to angiotensin antagonists in patients with ESRD, angiotensin antagonists possess a number of pharmacokinetic and adverse effect characteristics, which would favour their use in this population.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/01/21 alle ore 03:05:23