Makindo Medical Notes

⚠️ First-dose hypotension is a known risk. 💡 Start at the lowest dose, ideally at night and in bed, particularly in heart failure. If hypotension occurs → lie patient down, raise legs, and give IV fluids if BP remains low.

💊 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 and angioedema.
• 📉 Lowers blood pressure without reflex tachycardia.

🎯 Indications / Dose

• ❤️ Hypertension – often as part of combination therapy.
• 💔 Cardiac failure due to systolic dysfunction.
• 🧪 Diabetic nephropathy and to reduce cardiac remodelling post-MI.
• ⚠️ In heart failure: always start at the lowest dose, titrate to highest tolerated.

📊 Dose Range (check U+Es, BP, and BNF guidance)

• ➡️ Starting dose: 2.5–5 mg OD PO (adjust for BP and renal function).
• ➡️ Maintenance/long-term dose: 10–20 mg OD PO (higher doses often used in hypertension).

⛔ Contraindications

• 🚫 Pregnancy & breastfeeding – teratogenic, causes birth defects.
• ⚠️ Severe aortic stenosis or hypertrophic cardiomyopathy.
• 🚫 Bilateral renal artery stenosis.
• ⚠️ Pre-existing hyperkalaemia.

🔄 Interactions

• ⚠️ With alteplase (tPA) → risk of angioneurotic oedema in acute stroke thrombolysis.
• ❌ Avoid NSAIDs (reduce efficacy and worsen renal impairment).
• ⬆️ Risk of hyperkalaemia when combined with potassium-sparing diuretics, ARBs, or supplements.

⚠️ Side Effects

• 📉 First-dose postural hypotension (see above).
• 💨 Cough (bradykinin-mediated).
• 😮 Angioedema (rare, but potentially life-threatening).
• 💧 Worsening renal function in bilateral renal artery stenosis.
• 🧪 Hyperkalaemia.
• 🌸 Urticaria, taste disturbance.

📋 Monitoring

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