Pharmacologic: angiotensin-converting enzyme (ACE) inhibitors
Alone or with other agents in the management of hypertension. Management of heart failure. Reduction of risk of death or development of heart failure after myocardial infarction.
ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation. Therapeutic Effects: Lowering of blood pressure in hypertensive patients. Increased survival and decreased symptoms in patients with heart failure. Increased survival after myocardial infarction.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache, weakness. Resp: cough. CV: hypotension, chest pain. GI: abdominal pain, diarrhea, nausea, vomiting. GU: erectile dysfunction, impaired renal function. Derm: rashes. F and E: hyperkalemia. Misc: ANGIOEDEMA.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Watch for signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician immediately of these signs.
Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.
Assess signs and symptoms of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) to help document whether drug therapy is effective in reducing these symptoms.
Watch for signs of impaired renal function, including decreased urine output, cloudy urine, or sudden weight gain due to fluid retention. Report these signs to the physician.
Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Monitor symptoms of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Notify physician because severe cases can lead to life-threatening arrhythmias and paralysis.
Implement aerobic exercise and cardiac conditioning programs to augment drug therapy and maintain or improve cardiovascular pump function.
Use caution during aerobic exercise and endurance conditioning in patients with heart failure or recovering from MI. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, unusual fatigue) or displays other criteria for exercise termination (See Appendix L).
Avoid physical therapy interventions that cause systemic vasodilation (large whirlpool, Hubbard tank). Additive effects of this drug and the intervention may cause a dangerous fall in blood pressure.
To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.