Pharmacologic: angiotensin-converting enzyme (ACE) inhibitors
Alone or with other agents in the management of hypertension.
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.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache. Resp: cough. CV: hypotension, chest pain, edema. GI: diarrhea, dyspepsia. GU: impaired renal function. Derm: flushing, rashes. F and E: hyperkalemia. MS: myalgia. Misc: ANGIOEDEMA, flu-like symptoms.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor 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.
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.
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 peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention or peripheral vasodilation.
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.
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.
Remind patients to take medication as directed to control hypertension even if they are asymptomatic.
Counsel patients about additional interventions to help control blood pressure, including regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.
Instruct patient to notify physician of a prolonged dry cough; drug therapy may need to be altered to resolve this side effect.
Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged headache, chest pain, flu-like symptoms, skin reactions (rash, flushing), ...