Makindo Medical Notes

⚠️ First-dose hypotension is a recognised risk. 💡 Always start at the lowest dose, ideally at night with the patient in bed. More frequent when used in heart failure than in hypertension. If hypotension occurs → lie patient flat, 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, leading to cough and angioedema.
• 📉 Lowers blood pressure without reflex tachycardia.

🎯 Indications / Dose

• ❤️ Hypertension – often part of combination therapy.
• 💔 Heart failure due to systolic dysfunction.
• 🧪 Diabetic nephropathy and reduction of post-MI cardiac remodelling.
• ⚠️ In heart failure: start with the lowest dose, but aim for the highest tolerated dose.

📊 Dose Range (check U+Es, BP, and target BP; always refer to BNF)

• ➡️ Starting dose: 2.5–5 mg PO OD or BD (depending on BP and renal function).
• ➡️ Maintenance/long-term dose: 10–20 mg PO BD (adjust according to renal function and BP response).

⚠️ Cautions

• Less effective as monotherapy in African-Caribbean patients (consider thiazides or CCBs as first-line per NICE guidance).

⛔ Contraindications

• 🚫 Pregnancy and breastfeeding – teratogenic (risk of birth defects).
• ⚠️ Severe aortic stenosis or hypertrophic cardiomyopathy.
• 🚫 Bilateral renal artery stenosis.
• ⚠️ Pre-existing hyperkalaemia.

🔄 Interactions

• ⚠️ With alteplase (tPA) → risk of angioedema in acute stroke thrombolysis.
• ❌ Avoid NSAIDs (reduce efficacy and worsen renal function).
• ⬆️ Hyperkalaemia risk with potassium-sparing diuretics, ARBs, or supplements.

⚠️ Side Effects

• 📉 Postural hypotension (especially after the first dose).
• 💨 Cough (bradykinin-mediated).
• 😮 Angioedema (rare, but potentially life-threatening).
• 💧 Reduced renal perfusion 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.