Combintation Rx with ACE-I

Q: 42 years old afro-american male with no known previous history is admitted to ICU with accelerated hypertension (HTN). He responded to intravenous infusion of anti-hypertensive. PO Angiotensin-converting enzyme inhibitor (ACE inhibitor) started as a monotherapy with partial response. Which of the following may work well with ACE inhibitors? (select one)

A) Angiotensin II receptor blockers (ARBs)

B) Beta-blockers (BB)

C) Calcium Channel blockers (CCB)

D) Diuretics

E) C and D

Answer: E

Afro-American patients do not respond well to monotherapy with ACE inhibitors. But, a similar response can be obtained with the addition of a low dose of thiazide (diuretic) - choices D & E. The combination of ACE inhibitors and diuretics provides a synergistic effect. It may also help to attenuate some metabolic responses that occur only due to diuretics, such as hypokalemia, diuretic-induced hyperglycemia, the elevation of cholesterol, and hyperurecemia.

Also, CCB also provides a good combination therapy with ACE inhibitors - choices C & E.

Although, BB can be used with an ACE inhibitor but the response may not be desirable - choice B.

ARBs should not be added with ACE inhibitors - choice A.

#cardiology

#hemodynamics

References:

1. Pickering TG. The use of angiotensin converting enzyme inhibitors in combination with other antihypertensive agents. Am J Hypertens 1991; 4:73S.

2. Materson BJ, Reda DJ, Cushman WC, et al. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. N Engl J Med 1993; 328:914.

3. Townsend RR, Holland OB. Combination of converting enzyme inhibitor with diuretic for the treatment of hypertension. Arch Intern Med 1990; 150:1175.