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ACE inhibitors are medications used to treat and manage hypertension, which is a significant risk factor for coronary disease, heart failure, stroke, and a host of other cardiovascular conditions. Most cases are primary and not attributable to any specific etiology. This activity reviews the indications, contraindications, activity, adverse events, and other key elements of ACE inhibitor therapy in the clinical setting related to the essential points needed by members of an interprofessional team managing the care of patients with hypertension and its related conditions and sequelae. Objectives: Identify the mechanism of action of ACE inhibitors. Summarize monitoring/follow-up for patients initiated on ACE inhibitor therapy. Review the dosing parameters adjusting or replacing ACE inhibitor therapy based on adverse events or inadequate therapeutic response. Explain the importance of ACE inhibitor therapy in hypertension management and how it affects therapeutic strategy as it pertains to improving care coordination and communication among the interprofessional team when using these agents to achieve therapeutic outcomes. Access free multiple choice questions on this topic.

Excessive doses of ACE inhibitors are usually well-tolerated, but they can cause hypotension, drop-in GFR, and electrolyte derangements. In addition, since ACE inhibitors block aldosterone, they can cause hyperkalemia and hyponatremia.[56][57] If the patient presents within 1 hour of ingestion and is awake and able to protect their airway, activated charcoal can be given. If they remain asymptomatic for 6 hours of observation, they can be considered medically stable for either discharge or referral to psychiatry.[58] For those with hypotension, fluids should be the first line of therapy. There is no antidote for ACE inhibitor poisoning. Naloxone has been used in captopril overdoses in the past with some success and can be a choice if intravenous fluids are not successful. Also, vasopressors are an option for the treatment of hypotension.[59]

ACE inhibitors are one of the most widely used drugs for hypertension and heart failure, but their popularity does not mean they do not require the management of an interprofessional team. Besides nephrologists and cardiologists, these drugs are widely prescribed by nurse practitioners and primary care providers. While ACE inhibitors are relatively safe, a pharmacist should examine the patient's medication record to verify dosing and check for drug-drug interactions. Nursing can provide patient counsel, monitor for interactions and adverse events, and report any issues to the prescriber. It is important to monitor renal function and levels of electrolytes regularly.[60] Because many ACE inhibitors are currently available, it is important to keep up with the guidelines and recommendations, and the pharmacist can help the prescriber in this area.[61] An interprofessional team approach will optimize ACE inhibitor therapy resulting in improved patient outcomes. [Level 5]