Moderate
Established
Mô tả
ACE inhibitors combined with loop diuretics can cause first-dose hypotension and acute kidney injury, particularly in volume-depleted patients.
Cơ chế
Volume depletion from furosemide activates the RAAS; abrupt ACE inhibition in this setting dramatically reduces angiotensin II–mediated vasoconstriction, causing precipitous blood pressure drops.
Ý nghĩa lâm sàng
First-dose hypotension and syncope are well-documented; acute tubular necrosis from reduced renal perfusion can occur in dehydrated or elderly patients.
Xử trí
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.