ABC Medical Notes.com

Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure

Significant hypotension with first dose. Start low dose and in bed perhaps at night for initiation. Seen more when used to manage heart failure rather than hypertension. If occurs - lie patient down and raise legs and start IV if BP still low.

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• Competitively inhibit angiotensin converting enzyme
• Prevent formation of Angiotensin II a potent vasoconstrictor
• Can lead to increased Bradykinin
• Blood pressure reduction without reflex tachycardia
• Dose Range Check U+E, document starting BP, identify target BP

Indications/Dose

Cautions

• May not be effective in African-Caribbean patients

Contraindications

• Pregnancy and breastfeeding - cause birth defects
• Caution in severe aortic stenosis and hypertrophic cardiomyopathy
• Renal artery stenosis, Hyperkalaemia

Interactions

• Alteplase leads to Angioneurotic oedema in stroke thrombolysis
• Avoid NSAIDs and drugs causing Hyperkalaemia (caution with potassium-sparing diuretics)

Side effects

• Significant hypotension with first dose. Start low and in bed perhaps at night for initiation.
• Seen more when used to manage heart failure rather than hypertension. If occurs - lie patient down and raise legs and start IV if BP still low.
• Nausea, Vomiting, Raised bradykinin causes Cough, Angioneurotic oedema
• Altered taste, Reduced renal perfusion with bilateral renal artery stenosis
• Hyperkalaemia (caution with potassium sparing diuretics)

Monitoring

• Check renal function 4 days and 2 weeks following initiation
• Check renal function 1 week after any increase in dose