The objective of this question is to highlight the fact that angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are relatively contraindicated even in patients with serum creatinine concentrations above 3 mg/dL. This is due to their beneficial effect on patients with impaired left ventricular function. It has a survival benefit with lower mortality. This benefit is seen in all kidney function strata.
1. Frances CD, Noguchi H, Massie BM, et al. Are we inhibited? Renal insufficiency should not preclude the use of ACE inhibitors for patients with myocardial infarction and depressed left ventricular function. Arch Intern Med 2000; 160:2645.
2. Evans M, Carrero JJ, Szummer K, et al. Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Myocardial Infarction Patients With Renal Dysfunction. J Am Coll Cardiol 2016; 67:1687.