ACE inhibitor therapy : SEs , monitoring and management NICE summary

This table provides a structured approach to managing monitoring / abnormal test results that may arise during ACE inhibitor therapy, particularly focusing on renal function and electrolyte imbalances. It should serve as a quick reference for clinicians to decide the best course of action for patient safety and effective treatment.

Monitoring Parameter	Timing	Rationale & Actions for Abnormal Test Results
Initial renal function & electrolytes	Before starting treatment	Establish baseline; can identify patients at higher risk for complications.
Dose & Titration	Start low and titrate upwards every 2–4 weeks	To achieve target BP or maximum advised/tolerated dose; minimizes first-dose hypotensive effects.
Renal function & electrolytes	1-2 weeks after each upward titration & annually thereafter	Identify any renal impairment or electrolyte imbalances early.
Blood Pressure	4 weeks after each dose change	Evaluate effectiveness and adjust dose as needed.
Hyperkalaemia or deteriorating renal function risk	Consider checking sooner (within 1 week)	For high-risk patients, such as those with diabetes, PVD, or pre-existing renal impairment.

Managing abnormal results

Abnormal Test Result	Recommended Action	Further Monitoring Timing
eGFR drop <25% or serum creatinine increase <30%	No dose modification is required.	Recheck levels in 1–2 weeks
eGFR drop ≥25% or serum creatinine increase ≥30%	Investigate...

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