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ORIGINAL ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 24-28

Limitations in using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in the management of heart failure due to comorbidities: An Indian scenario


1 Department of Cardiology, Badr Al Samaa Hospital, Muscat, Oman and Former PhD Fellow in the Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
2 Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
3 Senior Registrar, Registrar in Department of Cardiology, Meditrina Hospital, Kollam, Kerala, India
4 Department of Cardiology and Medicine, Irkutsk State Medical University, Irkutsk, Russia

Correspondence Address:
Dr. Suman Omana Soman
Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ACCJ.ACCJ_1_18

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Background and Objectives: The essential drugs used in heart failure are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Many trials had shown that these are the group of drugs with maximum benefits for the patients with heart failure. However, most of the patients were not receiving these drugs due to the negative impact of the comorbidities. Our study aims at identifying the limitations in giving ACE/angiotensin receptor blockers (ARBs) in chronic heart failure patients in our population. Methods: This is a prospective observational study conducted in a tertiary care center, over a period of 2 years from 2012. We selected 310 consecutive patients with the New York Heart Association (NYHA) Class 3 or 4 with various etiologies of heart failure. The patients with new-onset myocardial infarction, acute inflammatory conditions, septicemia, and end-stage renal disease with glomerular filtration rate (GFR) <30 were excluded from the study. Results: In our study population of 310 patients with various etiologies of heart failure, only 60.3% (187) of the patients received ACE/ARBs, in which 34.5% (107) received ACE inhibitors and 16.4% (n-51) received ARB s. Hence, we noticed that 39.7% (n-123) of the patients with heart failure could not receive these drugs due to renal failure (10.3%), hyperkalemia (13.5%), and hypotension (15.8%). Conclusion: We noticed that many of the patients (39.7%) with heart failure did not receive these drugs due to comorbidities. We found that many patients had moderate renal failure with a significant reduction in GFR. Hypotension may be due to reduced ejection fraction because of the patient selection of Class NYHA 3 or 4. Hypotension may reduce the GFR and hence the progressive rise of serum creatinine. Careful patient selection and detailed evaluation alone can improve the number of subjects to whom the above drugs can be given.


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