Makindo Medical Notes

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.

About: Always check the BNF link here

• Competitively inhibits angiotensin-converting enzyme
• Prevent formation of Angiotensin II a potent vasoconstrictor
• Can lead to increased Bradykinin
• Blood pressure reduction without reflex tachycardia

Indications/Dose

• Hypertension - often as combination therapy
• Cardiac failure due to systolic dysfunction
• Diabetic nephropathy, Reduce cardiac remodelling post-MI
• Start the lowest dose for CCF and titrate to a highest tolerated dose

Dose range: Check U+E, BP, target BP. Check BNF

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
• Hyperkalaemia (caution with potassium sparing diuretics)

Side effects

• Significant Postural hypotension with the first dose. See above
• Raised bradykinin causes Cough, Angioneurotic oedema
• Reduced renal perfusion with bilateral renal artery stenosis
• Hyperkalaemia (caution with potassium sparing diuretics)
• Urticaria, taste disturbance

Monitoring

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