Role of renin–angiotensin–aldosterone system inhibitors in heart failure and chronic kidney disease

• Authors: Namrata Singhania, Mount Carmel East Hospital; Saurabh Bansal, University of Illinois; Shreya Mohandas, Emory University; Divya P. Nimmatoori, GreenField Health; Abutaleb A. Ejaz, University of Florida; Girish Singhania, St. Vincent Infirmary Medical Center
• Journal Title: Drugs in Context
• Volume: Volume 9
• Publisher: Drugs in Context | 2020-11-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7573/DIC.2020-7-3
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Pharmacology
• Keywords: RAAS; acute heart failure; chronic heart failure; chronic kidney disease; renin-angiotensin-aldosterone system inhibitors

Abstract

Renin–angiotensin–aldosterone system (RAAS) inhibitors are the key medications for patients with heart failure and chronic kidney disease. Multiple randomized controlled trials have demonstrated their benefits in an outpatient setting for the treatment of chronic heart failure. Additional advantages in acute heart failure treatment during inpatient hospitalization are less clear but a small number of non-randomized studies have favored their use. Conditions that result in stoppage of RAAS inhibitors during inpatient stay are an increase in serum creatinine, hyperkalemia, and hemodynamic instability such as hypotension. The role of RAAS inhibitors in chronic kidney disease has also been documented in multiple randomized controlled trials, with their use in hypertension and proteinuria being unambiguous. This narrative review summarizes the role of RAAS inhibitors in acute and chronic heart failure and chronic kidney disease.