RAS inhibitors, which include the generics enalapril, lisinopril, ramipril and others, used to treat high blood pressure have been shown to, over time, wreck the kidneys’ ability to filter and purify blood.
UVA researchers found that the drugs essentially rewire the kidneys to do something other than the important work of filtering blood. The kidneys start producing more of a hormone called renin; nerve endings grow excessively; cells lining the kidneys’ tiny blood vessels get too large; scars form and spread; and inflammation sets in.
The article is paywalled, but I am hoping to figure out if we should expect the same effect from ARBs.
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adssx
#2
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adssx
#3
Note: the paper used captopril only. And it’s in mice. So does it translate to all ACEi? To humans? To ARBs? Long way to go…
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adssx
#5
Note 2: it’s a research letter, not a regular article. They would have published a proper article if the results were that important. And they would give a title such as “The nephrotoxic effect of captopril in a mouse model of CKD” rather than “Transformation of the Kidney into a Pathological Neuro-Immune-Endocrine Organ”. In the Medical Xpress article, the main author says: “The most commonly used and believed-to-be-safe blood pressure medications may be damaging the kidneys”. The article was published on October 1st. And yet, NO ONE is commenting on it on Twitter.
I think (hope?) that for now, we can dismiss this paper…
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Well, we’ve been using these medications for a while now, in lots and lots of people, do we see any signal in a clinical setting? Or case reports? We need something concrete to hang our hats on, otherwise all this generates is free-floating anxiety, with no release through research. I mean, what do we do with this info?
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jakexb
#7
Have we not seen mild life extension effects with ARBs?
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Ray1
#8
We know that chronic hypertension is very hard on the kidneys. This seems like another area where more long term research is needed. If I had blood pressure issues, I would still take an ARB like Telmisartan based on what we know now.
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Exactly. Would we not see an increase in all cause mortality?
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sudiki
#10
Huh. Interesting. both of my Dr’s say that lisinopril is good for the kidneys. (I have issues with my GFR).
I only take 2.5mg though.
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Tim
#11
It’s well known that ACE-inhibitors can further damage kidneys during and after an acute injury. I don’t think ARBs have been implicated to the same degree. A few years ago, when I was hospitalized with AKI, I was taken off lisinopril because of the danger it posed. They put me on amlodipine and telmisartan instead.
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Gokhan
#12
I wouldn’t come to a strong conclusion from only one study.
- RAS inhhibition (ACE inhibitors and ARBs) are some of the first line therapy against chronic kidney disease. These effects are proven in humans using human doses, not in mice using mice doses (and not using Captopril — very few people use that drug today).
- Captopril was found to extend lifespan in mice by ITP — the most robust evidence for mice life extension.
So if anything this single article is almost surely BS (either the dosage is wrong, or the drug is wrong or something else).
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tarman
#13
I dove into this rather deeply. From my research, this article includes drugs that inhibit renin production, but not necessarily ARBs
So perhaps benicar and other ARBs are fine. This makes sense with Renin inhibition though that the body would react by trying to produce more.
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Bruce
#14
Consider if Telmisartan type drugs may lead to kidney issues with long term usage.
I believe we may soon start to hear about how daily use of Tadalafil causes dysregulation of the cGMP pathway.
adssx
#15
No @Bruce, read this thread, it’s bullshit.
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