Pharmacological Treatment of Hypertension and Heart Failure
Angiotensin-Converting Enzyme (ACE) Inhibitors – Benazepril (Lotensin)
This is the first-line drug of choice in the treatment of heart failure (Lother, 2016).
Mechanism of Action
The drug acts through vasodilation of the heart’s arterial and venous sides by interrupting the renin-angiotensin-aldosterone system. It binds to the active site of ACE, blocking the conversion of angiotensin I to angiotensin II, both potent vasoconstrictors. It mainly improves cardiac function by reducing both preload and afterload.
Angiotensin II affects aldosterone-mediated sodium and water retention by the kidneys, and its inhibition decreases the circulating volume, decreasing preload and indirectly decreasing afterload by producing vasodilation (Whalen, Feild & Radhakrishnan, 2012).
Hints for Monitoring
ACE inhibitors should be used cautiously in patients with high serum potassium levels, renal artery stenosis, and low systemic blood pressure (systolic BP < 80mmHg). Serum potassium levels and renal function should be monitored approximately two weeks after the initiation of therapy and then periodically (Lother, 2016).
Side Effects
The most common side effects are dizziness, fatigue, headache, diarrhea, coughing, and hypotension. Coughing is usually the most frequent, with patients describing it as dry and nagging. The benefits, however, outweigh the adverse effects, and therefore patients should be advised to stay on the medication if the side effects are tolerable (Whalen, Feild & Radhakrishnan, 2012).
Drug Interactions
NSAIDs, diuretics, and ARBs, when used in combination with ACE inhibitors, increase the potential for hypotension and renal impairment. Potassium supplements and ACE inhibitors increase the potential for hyperkalemia. Lastly, ACE inhibitors increase the concentration of lithium in the blood (Whalen, Feild & Radhakrishnan, 2012).
CAM
Hydralazine and isosorbide dinitrate are the favored drugs for vasodilator therapy in combination with ACE inhibitors. Hydralazine is an arteriolar dilator, while isosorbide is a venodilator. Diuretics combined with ACE inhibitors are also recommended in heart failure patients with volume overload (Lother, 2016).
Patient Outcome
A patient on benazepril (Lotensin HTC) treatment for hypertension reported a dry, persistent cough and a decrease in white blood cells on the blood panel, which predisposed the patient to the risk of infection. The drug was, however, useful in reducing his blood pressure significantly.
References
Lother, A., & Hein, L. (2016). Pharmacology of heart failure: From basic science to novel therapies. Pharmacology & therapeutics, 166, 136-149.
Whalen, K., Feild, C., & Radhakrishnan, R. (2012). Lippincott illustrated reviews (5th ed., pp. 197-200).
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Pharmacological Treatment of Hypertension and Heart Failure
Select a medication used for the treatment of chronic hypertension, malignant hypertension, heart failure, or dyslipidemia.
Pharmacological Treatment of Hypertension and Heart Failure
- Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including CAM, of which one should be aware.
- In addition, share a time when the use of this medication resulted in a positive or negative outcome in a patient for whom you were caring.
- Include the name of the medication in the subject line so that the medications can be followed.
Include references using APA format
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