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Early renin–angiotensin system inhibition induced renal deterioration may be a predictor for long-term cardiorenal outcomes

Commentary on: Schmidt M, Mansfield KE, Bhaskaran K, et al . Serum creatinine elevation after renin–angiotensin system blockade and long term cardiorenal risks: cohort study. BMJ 2017;356: j791.

An increase in serum creatinine level may occur in the first 2 weeks that follow ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy as a consequence of lowering intraglomerular pressure. Such renal impairment at baseline should stabilise within 2–4 weeks assuming normal volume and sodium intake. Renal function might deteriorate further when increasing the dose of diuretics, initiation of non-steroidal anti-inflammatory drugs (NSAIDs) or development of volume depletion from non-diuretic-induced causes such as gastroenteritis.1 Most guidelines recommend monitoring and stopping the treatment, if there is a creatinine increase of 30% or more. Recent studies have shown that ACEI and ARBs may be particularly effective in lowering the incidence of cardiovascular events.2 

This study examined the incidence of cardiorenal events in ACEI/ARB …