Potential Nephrotoxicity of Lisinopril and Valsartan on Patients with Congestive Heart Failure

Abstract

Lisinopril (angiotensin converting enzyme inhibitor) and valsartan (angiotensin II receptor
blocker) are the first-line treatment for patients with congestive heart failure (CHF). These
two drugs potentially cause side effects on renal functions. However, limited information
was available regarding the comparison of potential nephrotoxicity of these drugs in Indonesian
CHF patients. This research was aimed to compare the potential nephrotoxicity
between lisinopril and valsartan in outpatients with CHF at a hospital in Palu, Indonesia.
This was an observational study conducted during April-May 2015. Potential nephrotoxicity
were assessed by measuring serum creatinin (SCr) and blood urea nitrogen (BUN). Data
were obtained from Cardiology Unit from a hospital in Palu, Indonesia. Statistical analysis
was conducted using T-test and Mann-Whitney test. The increasing trend of SCr and BUN
were observed in lisinopril-treated patients with the mean of increase were 21% and 59%,
respectively. Relatively higher increase was observed in valsartan treatment group with 47%
and 51% in SCr and BUN, respectively. The analysis showed that there were significant differences
in SCr level between lisinopril and valsartan groups (p=0.001), but the opposite
results observed in BUN parameter (p=0.697). Therefore, valsartan was potentially more
nephrotoxic than lisinopril based on the increase of SCr parameter. Thus, lisinopril is recommended
for CHF patients who are particularly at high risks of having renal impairment.

Keywords: lisinopril, valsartan, nephrotoxicity, congestive heart failure