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ACE Inhibitor Therapy for Hypertension

ACE Inhibitor Therapy for Hypertension

Suzanne Harvie
M00306212
Interamerican University
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ACE Inhibitor Therapy for Hypertension

Prototype Drug: Enalapril (Vasotec)

Adults: not taking diuretics, initially 5 mg PO once daily, then adjusted on response.
Usually 10 to 40 mg daily as a single dose or divided. Or 1.25 mg IV infusion over 5
minutes q 6 hours

The rennin-angiotensis system is a key homeostatic mechanism controlling blood pressure

and fluid balance. To review, rennin is an enzyme excreted by special cells in the kidney
when BP falls, or when there is a decrease in Na+ flowing through the kidney tubules. Once
in the blood, rennin converts the inactive liver protein angiotensinogen to angiotensin1,
when is converted to angiotensis II, one of the most potent natural vasoconstrictors known.
The enzyme in this system is angiotensin-converting enzyme (ACE). The intense
vasoconstriction raises the blood pressure by increasing peripheral resistance.

In patients with HTN, ACE inhibitors block the effects of angiotensin II, decreasing the
blood pressure by lowering peripheral resistance and decreasing blood volume.

Side effects: Usually minor and include persistent cough and postural hypotension,
particularly following the first few doses of the medication. Hyperkalemia may occur and
can be a major concern for diabetics, people with renal impairment and those taking
potassium-sparing diuretics. A rare serious side effect is the development of angionedema,
which usually occurs right away but can occur later, too. Headache, dizziness, risk for falls.

Desired Effects: Exhibit a reduction in systolic and diastolic pressure. Maintain normal
serum electrolyte levels during drug therapy.

Nursing Diagnosis: Injury, Risk for, related to orthostatic hypotension

Knowledge, Deficient, related to drug therapy
Nutrition imbalanced: more than body requirements, related to hyperkalemia

Interactions: Drug-Drug: When given concurrently, other antihypertensives have additive

effects. Thiazide diuretics increase potassium loss. Potassium supplements or potassium-
sparing diuretics increase rick of hyperkalemia. May cause lithium toxicity. NSAIDs may
reduce action of ACE-inhibitors[ CITATION Mic08 \l 1033 ]

Treatment of Overdose: IV infusion of NSS for hypotension

Evidence Based Research: Comparative Effectiveness of ACE Inhibitors and ARB’s for
Treating Essential Hypertension. Agency For Healthcare Research and Quality, February,
2004. Conclusion: There is a dirth of information in this area, and it is not clear which
drug works better for hypertension, More research needs to be done.
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Bibliography
Agency for Healthcare Research and Quality. (2009, 02 07). Contents of Comparative
Effectiveness of Angiotensis-Converting Enzyme Inhibitore (ACEIs) and Angiotensin II
Recpetor ANtagonists (ARBs) for Treating Essentian Hypertension: AHRQ Executive
Summary. Retrieved 03 23, 2010, from Medscape:
http://cme.medscape.com/viewarticle/569559
Michael Patrick Adams, e. a. (2008). Pharmacology for Nurses: A Pathophysiologic Approach
(2nd Edition ed.). Upper Saddel River, NJ, USA: Pearson/Prentice Hall.