Hypertension remains a significant public health issue in SA, of particular concern is the high prevalence but lack of awareness, particularly among men and young adults.1
ACE inhibitors (angiotensin-converting enzyme inhibitors) are commonly used for the treatment and management of hypertension. They work by inhibiting the angiotensin-converting enzyme, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor that increases blood pressure. By inhibiting this enzyme, ACE inhibitors reduce the levels of angiotensin II, leading to vasodilation and, consequently, lower blood pressure.2,3
Pharmacy Magazine spoke to pharmacist and ICPA CEO, Jackie Maimin, who shared five counselling tips that pharmacists should provide to patients prescribed an ACE inhibitor for hypertension.
- TAKE MEDICATION AT THE SAME TIME DAILY
Advise patients to take their angiotensin-converting enzyme inhibitors (ACEI) consistently, ideally at the same time each day. This helps maintain stable blood pressure and ensures the medication's effectiveness. If they miss a dose, they should take it as soon as possible unless it's near the time of their next dose. - PREGNANCY WARNING
Advise women of child-bearing age who have been prescribed an ACEI to use an effective contraceptive as ACEIs are known to be teratogenic and are contraindicated in the second and third trimesters of pregnancy. - MONITOR FOR COMMON SIDE EFFECTS ESPECIALLY A DRY COUGH
Pharmacists should be aware that a dry cough is the most common adverse effect of ACEI, and that this symptom may occur not necessarily shortly after institution of therapy but months or even a year later. Replacement by another ACEI should not be tried, since the cough will almost always recur on rechallenge with the same or another ACEI. After withdrawal of the ACE inhibitor, which is the treatment of choice, cough will resolve usually within a few days. - STAY HYDRATED AND AVOID EXCESS POTASSIUM
ACEIs are potassium sparing. Warn patients about the risk of high potassium levels (hyperkalaemia), especially if they are taking potassium supplements or salt substitutes. Encourage them to stay hydrated and avoid OTC potassium supplements unless prescribed. - REPORT ANY SWELLING OR BREATHING DIFFICULTIES
Advise patients to seek immediate medical attention if they experience swelling of the face, lips, or throat, or difficulty breathing, as these could be signs of a rare but serious allergic reaction called angioneurotic oedema. In a patient having experienced ACE inhibitor-related angioedema, ACEI medicines as a class are a contraindication going forward and angiotensin receptor blockers should be used cautiously if at all.
These tips help ensure patients are informed and can manage their hypertension effectively while minimising risks.
