Effects of therapy with the ACEI fosinopril and the angiotensin II antagonist valsartan on the nitrogen-excretory renal function in patients with chronic heart failure and renal insufficiency
Urgency. At present time studies of the relationship between laboratory and instrumental data on renal function and their changes during therapy for CHF are scanty. Aim. Studying the effect of treatment with the ACEI fosinopril and the ARAII valsartan on renal function evaluated by results of laboratory tests and dynamic nephroscintigraphy in patients with severe CHF. Materials and methods. Study enrolled 60 patients with IHD complicated with III-IV FC CHF. Patients were randomized to two groups; group 1 received a therapy including fosinopril, and group 2 received a therapy including valsartan. Blood tests (creatinine, urea), urinary tests (MAU, proteinurea), Reberg test, ECG, echoCG, 6-min walking test, and evaluation of life quality using the Minnesota questionnaire were performed at baseline (decompensation period), after 3 weeks (stabilization period) and after 6 months of treatment. Dynamic nephroscintigraphy was performed at 3 weeks and 6 months. Results. Long-term treatment with the ACEI fosinopril and the ARAII valsartan improved clinical and functional condition of patients with CHF to a similar extent, provided reduction and/or normalization of serum creatinine level and increased GFR. It was noted that a significant number of such patients with «high normal» creatinine level as shown by data of dynamic nephroscintigraphy had reduced blood parameters of GFR. Therefore, even when the creatinine level is within "high normal" values, and even more so when it is slightly or moderately increased, more comprehensive examination of renal function is warranted for patients with CHF. A detected impairment of GFR requires individualizing the regimen of ACEI or ARAII treatment.