Abstract
The objective of the present study was to determine whether pretreatment neurohormonal and renal hemodynamic parameters predict the change in renal function with the administration of quinapril, a new angiotensin-converting enzyme (ACE) inhibitor. Twenty patients with New York Heart Association (NYHA) class III and IV heart failure were evaluated. Following pretreatment determination of renal function and plasma neurohormones, patients were treated daily with 10 mg of quinapril. Measurements of glomerular filtration rate (GFR) and renal plasma flow (RPF) were repeated after 7 weeks to assess changes in function (ΔGFR and ΔRPF). Mean GFR increased from 49 ± 6 to 56 ± 7 ml/min/1.73 m 2 ( p = 0.10), but decreased in five patients. Mean RPF increased from 235 ± 23 to 252 ± 23 ml/min/1.73 m 2 ( p = 0.08), but decreased in five patients. There was no relation between ΔGFR and baseline determinations of GFR, RPF, plasma renin activity, plasma angiotensin II, or serum Na. Only a high filtration fraction ( GFR RPF ) predicted a decreased GFR ( r = 0.61, p < 0.005). In contrast, no baseline renal hemodynamic parameter correlated with ΔRPF. We conclude that poor renal function does not increase the risk of renal deterioration with quinapril. However, dependence of renal function upon the renin-angiotensin system may be predicted by a high filtration fraction.
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