ACE inhibitors (eg, captopril, enalapril, lisinopril) or ARBs, such as telmisartan, losartan, irbesartan, and candesartan, are the agents of choice for blood pressure control in patients with ADPKD. ACE-inhibitor use has multiple benefits in PKD patients. As shown in animal studies, activation of RAAS may promote renal-cyst growth due to mitogenic effects.
In a post hoc study of the TEMPO 3:4 trial, long-term treatment with the vasopressin V2 receptor antagonist tolvaptan was shown to gradually lower blood pressure compared with placebo. This may be the result of a beneficial effect on the progression of ADPKD, a continued natriuretic effect, or both. Tolvaptan is prescribed to patients with ADPKD to slow disease progression.
Among patients with advanced renal disease, both ACE inhibitors and ARBs may increase serum potassium levels or exacerbate renal failure. Regular monitoring of serum chemistry values in these patients is recommended.
Learn more about evolving insights into the management of ADPKD.
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Cite this: Neera K. Dahl, Maryam Gondal. Fast Five Quiz: Autosomal Dominant Polycystic Kidney Disease Management - Medscape - Sep 08, 2022.