Pharmacologic: angiotnsin-converting enzyme (ACE) inhibitors
Alone or with other agents in the management of hypertension. Reduction of risk of death from cardiovascular causes or nonfatal myocardial infarction in patients with stable coronary artery disease.
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 patients with hypertension. ↓ risk of death from cardiovascular causes or myocardial infarction in patients with stable coronary artery disease.
Adverse Reactions/Side Effects
CNS: dizziness, headache, weakness. Resp: cough. CV: hypotension. GI: diarrhea, dyspepsia. GU: impaired renal function. Derm: rashes. F and E: hyperkalemia. MS: back pain. 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.
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 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.
Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
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.
Use caution during aerobic exercise and other forms of therapeutic exercise in patient with stable coronary artery disease. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (see Appendix L).