Quickly, 'cause it's late...or early...
Nephrotoxicity.
ACEIs have effects on the kidneys, hence monitoring of renal function, contraindication for use in patients with elevated Cr levels and using ARBs in folks with impaired renal function. NSAIDs are the same. Combine the possible toxic effects of these drugs with a disease state that may not be providing adequate perfusion to the kidneys, you've got a recipe for renal failure. And that's the last thing those folks need! Don't forget to factor in the zealous use of diuretics (lasix et. al.) in CHFers - another stress on those kidneys. Besides, if the kidneys don't work, how are ya' going to get the fluid off?
My $0.02
Cheers,
Tom
feel free to correct me...I may be way off and like I said, it is early/late...
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