10th July 2026

Cardiovascular drugs

ACE Inhibitors (ACEI) and (Angiotensin Receptor Blockers) ARBs can improve outcomes in patients with renal impairment and reduce proteinuria. They must, however, be used with caution in the elderly, those taking other high-risk drugs such as NSAIDs, loop diuretics, spironolactone, and patients with diabetes (higher risk of renal artery stenosis). They can cause a decline in renal function in these patients and hyperkalaemia. 

Monitoring renal function should be done after 3-4 days and 7-10 days of introduction of the drug. A creatinine rise is expected initially, but anything over 20-30% is significant.  

In renal impairment, statins and fibrates are more likely to cause myopathy, and should have dose reductions.