Описание
ACE inhibitors combined with loop diuretics can cause first-dose hypotension and acute kidney injury, particularly in volume-depleted patients.
Механизм
Volume depletion from furosemide activates the RAAS; abrupt ACE inhibition in this setting dramatically reduces angiotensin II–mediated vasoconstriction, causing precipitous blood pressure drops.
Клиническое значение
First-dose hypotension and syncope are well-documented; acute tubular necrosis from reduced renal perfusion can occur in dehydrated or elderly patients.
Тактика ведения
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.
Медицинский отказ от ответственности
This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making medication decisions.