ACE Inhibitors are one of the most commonly prescribed medications for hypertension.  ACE Inhibitors do have precautions, contraindications, and rug interactions that we need to be aware of.  Here’s a list of a few important clinical pearls that need to be managed with ACE Inhibitors.

1. Potassium is the number one electrolyte that needs to be monitored.  While most recognize that potassium should be checked following initiation and increase, we also need to think about ACE inhibitors being discontinued as many patients who are on ACE inhibitors may also be taking diuretics which can deplete potassium.  It is very important in the situation of a patient on the lower end of normal.  (i.e. 3.5-3.7ish range)
2. Drug interactions.  Drug interactions are not incredibly common with ACE inhibitors compared to other medications classes, but they certainly do exist.  ACE inhibitors with other potentially nephrotoxic medications (NSAIDs, diuretics etc.) is a significant concern.  One of my favorite case studies from the blog was this case involving TMP and hyperkalemia.
3. Compelling indications.  ACE inhibitors have quite a few compelling indications and this is a major reason why they are used so frequently for hypertension.  Rarely do I find a situation where a geriatric patient with hypertension or patient on multiple antihypertensives is not on an ACE inhibitor.  When you find that a patient with hypertension is not on an ACE inhibitor, I would strongly recommend investigating the past medical history as there is likely a good reason why they aren’t.

Looking for more useful clinical medication content? Check out the 30 medication mistakes, from my everyday practice as a pharmacist.