Moderate
Established
説明
ACE inhibitors combined with loop diuretics can cause first-dose hypotension and acute kidney injury, particularly in volume-depleted patients.
機序
Volume depletion from furosemide activates the RAAS; abrupt ACE inhibition in this setting dramatically reduces angiotensin II–mediated vasoconstriction, causing precipitous blood pressure drops.
臨床的意義
First-dose hypotension and syncope are well-documented; acute tubular necrosis from reduced renal perfusion can occur in dehydrated or elderly patients.
対処法
Start ACE inhibitor at the lowest dose (e.g., lisinopril 2.5–5 mg); ensure patient is not hypovolemic before first dose; withhold furosemide 24–48 hours before ACE inhibitor initiation if volume-depleted.