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Nephrol Dial Transplant (2003) 18: 1973-1975
© 2003 European Renal Association-European Dialysis and Transplant Association

Editorial Comment

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: what to do if the serum creatinine and/or serum potassium concentration rises

Biff F. Palmer

Department of Medicine, Division of Nephrology, University of Texas Southwestern Medical School, Dallas, TX, USA

Correspondence and offprint requests to: Biff F. Palmer, MD, Professor of Internal Medicine, Department of Medicine, Division of Nephrology, University of Texas Southwestern Medical School, 5323 Harry Haines Boulevard, Dallas, TX 75390-8856, USA. Email: biff.palmer@utsouthwestern.edu

Keywords: angiotensin-converting enzyme inhibitors; angiotensin receptor blockers; hyperkalaemia; hypertension; serum creatinine

The first 10% of the full text of this article appears below.

Introduction

Guidelines governing the optimal treatment of blood pressure in patients with chronic renal failure emphasize the need for more stringent blood pressure control and the use of drugs that interfere with the renin–angiotensin system [1,2]. As this approach is adopted, physicians will commonly encounter patients where blood pressure control is accompanied by an increase in the serum creatinine concentration and patients who develop hyperkalaemia. How physicians respond to these events is of considerable importance.

In the patient with an increase in serum creatinine concentration, decreasing the dose of antihypertensive medications and allowing blood pressure to increase will cause the serum creatinine concentration to return to the original baseline. Unfortunately, such an approach is not optimal for the long-term preservation of renal function and should be discouraged. Small and non-progressive increases in the serum creatinine concentration accompanying better blood pressure control do not reflect structural . . . [Full Text of this Article]

Blood pressure control and increases in the serum creatinine concentration

Hyperkalaemia complicating the use of ACE inhibitors and ARBs


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