Hypertension Protocol

Major side effect is peripheral edema

Dose related, much less likely at 2.5, 5 mg doses Can start > 6 months after initiation

Does NOT improve with diuretic therapy
Does improve with co- administration of ACE inhibitor / ARB

Can also cause headache, lightheadedness, flushing Long-term use can lead to gingival hyperplasia

Screen for dry cough, if present switch to ARB

If hypokalemia is an issue, consider:

• A low-sodium, high-potassium diet
• Adding spironolactone, will reduce blood pressure and increase K
• Thiazide-like diuretic combination should be considered first-line in osteoporosis, edema, calcium nephrolithiasis with hypercalciuria

• Spironolactone: gynecomastia, breast tenderness, and erectile dysfunction risks increases with higher doses

• Eplerenone does not have these side effects but is slightly more expensive and less potent, may need to be used twice daily