Makindo Medical Notes

⚠️ First-dose hypotension is a recognised complication. 💡 Start with the lowest dose, ideally at night and with the patient in bed. If it occurs → lie patient down, raise legs, and give IV fluids if BP remains low. More common when used in heart failure than in hypertension.

💊 About: Always check the BNF link here

• 🔹 Competitively inhibits angiotensin converting enzyme (ACE).
• 🛑 Prevents formation of angiotensin II, a potent vasoconstrictor.
• ⬆️ Increases bradykinin, contributing to cough/angioedema.
• 📉 Lowers blood pressure without reflex tachycardia.

🎯 Indications / Dose

• ❤️ Hypertension – often part of combination therapy.
• 💔 Cardiac failure due to systolic dysfunction.
• 🧪 Diabetic nephropathy, CKD with proteinuria.
• 💊 Post-MI – reduces cardiac remodelling.
• ⚠️ In heart failure: always start low, aim for highest tolerated dose.

📊 Dose Range (BNF – always check U+Es, BP, and target BP)

• ➡️ Starting dose: 1.25–2.5 mg OD PO (depending on BP and renal function).
• ➡️ Maintenance/long-term dose: 5–10 mg OD PO (titrated to effect and tolerance).

⚠️ Cautions

• ❗ Less effective as monotherapy in African-Caribbean patients (consider thiazide/CCB first per NICE HTN guidance).
• Monitor closely in elderly or those with borderline renal function.

⛔ Contraindications

• 🚫 Pregnancy – teratogenic (renal maldevelopment, skull hypoplasia).
• ⚠️ Severe aortic stenosis or hypertrophic cardiomyopathy (risk of collapse).
• 🚫 History of ACE inhibitor–induced angioedema.

🔄 Interactions

• ⚠️ With alteplase (tPA) → ↑ risk of angioedema in acute stroke thrombolysis.
• ❌ Avoid concomitant NSAIDs (worsen renal impairment, blunt antihypertensive effect).
• ⬆️ Risk of hyperkalaemia with potassium-sparing diuretics, ARBs, or supplements.

⚠️ Side Effects

• 📉 Postural hypotension (especially after first dose).
• 💨 Dry cough (bradykinin-mediated).
• 😮 Angioneurotic oedema (rare but potentially life-threatening).
• 💧 Worsening renal function in bilateral renal artery stenosis.
• 🧪 Hyperkalaemia.
• 🌸 Rash, urticaria, taste disturbance (metallic taste).

📋 Monitoring

• 🔍 Check renal function and electrolytes at 4 days and 2 weeks after initiation.
• 📈 Repeat 1 week after any dose increase.
• ⚠️ Stop or reduce dose if creatinine rises >30% or K⁺ >6.0 mmol/L.