Acute changes in glomerular filtration rate with renin-angiotensin system (RAS) inhibition: clinical implications.

Renin-angiotensin system inhibition with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers has been shown to be effective in reducing progression of renal and cardiovascular disease. However, these medications are often associated with an initial reduction of estimated glomerular filtration rate, which is thought to be functional but may be of clinical significance. Newer insights from secondary analyses of large clinical trials may provide important clinical perspective.