ACE Inhibitors and Angiotensin II receptor antagonists

Question 1

Monitoring

Answer 1

Blood pressure, renal function, serum electrolytes

Question 2

Warning Signs

Answer 2

• Dizziness, light-headedness on standing, blurred vision (postural hypotension)
• Jaundice or marked elevation of hepatic enzymes
• Abnormal renal function (renal artery stenosis)
• Water retention
• Anuria, confusion, nausea, vomiting and dehydration (acute kidney injury)

Question 3

Actions Required

Answer 3

• Advise patients to report immediately to a doctor if any warning signs occur
• Approximately 1 in 10 people will experience a dry, irritating cough when taking ACE
inhibitors. It can take between 8 to 12 weeks for the cough to disappear after stopping the
ACE inhibitor
• Patients should have a routine blood test to check their renal function and serum
electrolytes 1 to 2 weeks after initiating treatment and 1 to 2 weeks after each dose
increase
• For hypertension, the first dose should preferably be given at bedtime
• Advise patients to drink adequate (not excessive) volumes of fluid each day
• Patients should temporarily stop these medications during sick days, when they are
experiencing diarrhoea or vomiting (unless minor); or fever, sweats and shaking to prevent
dehydration which can lead to acute kidney injury

Question 4

Interactions

Answer 4

• ACE inhibitors and angiotensin II receptor antagonists increase the concentration of lithium.
• ACE inhibitors and angiotensin II receptor antagonists increase serum potassium.
Concurrent use of other drugs that increase serum potassium can increase the risk of
hyperkalaemia (refer to BNF guide medication that cause hyperkalaemia).
• Increased risk of renal impairment when ACE inhibitors and angiotensin II receptor
antagonists given with aliskiren.