Practical Tips
Consider reducing the dose of diuretic if the patient is otherwise stable, and reassess the need and the dose of other vasodilators, such as long-acting nitrate, if no longer clinically needed.
An increase in serum creatinine of up to 30 % is not unexpected in many HF patients when an ACEi or ARB is introduced; if the increase stabilizes at 30 % or less, there is no immediate need to decrease the drug dose but closer long-term monitoring may be required.
MRA can increase serum potassium, especially during an acute dehydrating illness where renal dysfunction can worsen, and close monitoring of serum creatinine and potassium is required.
Combining an ARB with an ACEi increases the risk of hypotension, hyperkalemia and renal dysfunction and it should be used with caution.