Mô tả
The ACE inhibitor and thiazide combination is guideline-recommended for hypertension but can cause first-dose hypotension and metabolic disturbances including hypokalemia or hyperkalemia.
Cơ chế
Thiazides promote sodium and potassium excretion, activating RAAS; ACE inhibition in this RAAS-activated state can cause pronounced blood pressure lowering. ACE inhibitors also retain potassium, partially offsetting thiazide-induced hypokalemia.
Ý nghĩa lâm sàng
This combination is generally well tolerated and broadly beneficial; potassium should be monitored as the net effect on potassium is variable.
Xử trí
Monitor electrolytes (potassium, sodium) and renal function within 4–6 weeks of initiating; adjust diuretic dose to avoid hypokalemia; first-dose hypotension counseling is important.