Side effects of ACEIs

[MudPhud20XX]

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are:
- Dry cough
- Hyperkalemia
- Acute renal failure in renal artery stenosis
- Angioedema

1. Can anyone explain the "Acute renal failure in renal artery stenosis?" How does ACEI lead to worsening artery stenosis? Does this have to do with the fact that ACEIs inhibit aldosterone, which dilate efferent arteriole in the kidney?

2. Also, ACEI is known to prevent ventricular remodeling that normally occurs as the severity of the heart failure increases. So why particularly the ACEI? How about diuretics or others such as beta blockers or Ca blockers?

Many thanks in advance.

 

[thehundredthone]

1. Efferent. In B/L RAS, the perfusion pressure is being maintained by severe efferent constriction (it's all about pressure gradients) via AT2. An ACEi nullifies that effect thereby dropping GFR and precipitating azotemia.

2. It is not clear how ACEis work but numerous theories abound, including anti-ischaemic properties and neurohumoural mechanisms. Also, carvedilol has in fact been shown to reverse remodelling in some. http://www.ncbi.nlm.nih.gov/pubmed/12783070