ACEI

ACEI in heart failure

In the initiation of ACEI, the following steps are recommended:

Care should be exercised in the following patients for whom referral to a specialist may be considered.

·        SBP <100mmHg

·        Creatinine >250 μmol/L (normal 130 micromol and less)

Avoid excessive diuresis before treatment. If patients are on large doses of diuretics, the blood pressure and renal function should be monitored.

Start with a low dose. Patients should not remain on the initial low dose indefinitely. The dose should be increased gradually to the target dose (Table

VI) or maximum tolerated dose.

What to monitor?

·        Monitor blood urea, creatinine and serum potassium at 7-14 days, especially in patients with impaired renal function.

·        If the rise in serum creatinine level is

      >20% compared to baseline, then ACEI therapy may      need to be stopped.

Things to avoid

·        Avoid potassium sparing diuretics during initiation of therapy.

·        Avoid non steroidal anti-inflammatory drugs

Major adverse effects of ACEI are:

·        cough

·        hypotension

·        renal insufficiency

·        hyperkalaemia

·        angioedema