ARB's vs ACE-I's

Specialties Cardiac

Published

OK, I am doing home health, and I have a question.

Ordinarily, I expect a pt to be on one kind of med per category. Eg, if I got into a home and pt has Lopressor and Toprol XL and is taking both, it is pretty easy to figure out why they have been dizzy, fell and have a slow HR!

I have had to thin out many people's meds in this way, taking 2 and sometimes 3 diff types of same category cardiac med.

So, now we come to ACE-I's and ARB's. I understand that of these categories work on a different part of the pathway of the renin-angiotensin system. The ARB's result in less cough as S/E. But what about the potential for renal failure.

I realize these agencts are cardioprotective in the long run, but I am concerend about the potential for renal failure, esp in the elderly. I have seen quite a few pt's end up with serious elevations of BUN/Creat from the ACE-I's.

My questions are these...

Is the potential for Renal Failure as high w ARB as it is w ACE-I's?

AND, isn't it overkill to have people on a drug in each of these categories at the same time?? I am seeing this more often, and can't get straight answer on this. Is it appropriate to treat pt w ACE-I and ARB simultaneously??

My gut says pick one, have their not been enough studies??

Thanks for your input.

Specializes in CTICU.

First off, you guys are responding to a 5 year old thread, so medical management would have changed significantly since the original post.

With regard to ACEI and ARBs - depends what you're treating. Yes, you want to be careful of the K+ with CRI patients, it may require a reduction of dose if hyperkalemia occurs. However, they may even exert a renal protective effect.

A big HOWEVER - there is overwhelming clinical evidence that ARBs and ACEIs reduce morbidity and mortality in certain patients, namely hypertension, MI, heart failure (and associated cardiorenal syndrome), diabetics..

There is tons of literature about this at the moment.

Specializes in Cardiac Telemetry, ED.

First off, I hate it when people drag up old threads. Just start a new one if you have a question!

Second, the idea that ACE inhibitors are contraindicated for patients with renal impairment is apparently still being taught in nursing schools.

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