Announcement

Collapse
No announcement yet.

What is the significance of combined therapy of an ACE inhibitor and a beta blocker?

Collapse
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • What is the significance of combined therapy of an ACE inhibitor and a beta blocker?

    Hi, I'm a second year pharmacy student, studying at the moment for my summer exams. In my lecture notes and past papers, there were so many times where the combined therapy mentioned in the title was mentioned. I remember a question asking,

    "Is this treatment safe or not? Please explain." or something along the lines of that. The only answer I could think of was that no (which I'm sure I am incorrect) because both lowers the human body's blood pressure, therefore would lead to hypotension and possibly fatigue and tiredness.

    Also I don't understand what it means when they say titrating the dose for this treatment. Does it mean that they'll increase the dose for each until the maximum therapeutic effectiveness has been reached for the patient?

    If anyone could give me an answer that would be easily understood for a university level patient, that'd be great.

  • #2
    I take both Candesartan and Atenolol. ACEs lower BP by decreasing kidney resistance to flow and Atenolol acts on bundle of Hiss to lower heart rate, thereby decreasing BP.
    You should remember A B C D
    Ace inhibitors, Beta blockers , Calcium antagonists and diuretics.
    I take Atenolol, Candesartan. Lercandipidine and Spironolactone. The combination has been very effective and I am in the process of lowering doses to prevent dizziness due to orthostatic hypotension.. ( Danger of falls). You must be totally at ease with the pharmacology.
    johnep

    Comment


    • #3
      a,b, c and d has changed a while back to a, c, d (with b being fourth line) unless Other issues except for essential hypertension present e.g. hf, mi etc ... NICE has a great algo for this. Worth looking at.

      To the OP ... may also be worth looking at cardiologytrials.org. Good summary of trials and the reasons behind certain combinations without me giving you the actual answer!!

      Comment


      • #4
        Just had a look on it and it doesn’t mention the trial I was thinking of!! Without giving too much away, have a look at the ASCOT trial. You may find something there that could benefit you.

        Comment


        • #5
          Ah this takes me back to my 4th year dissertation "Why were the recommendations for prescribing antihypertensives changed in 2006?"

          An ACE + Beta Blocker is not dangerous, but its not a preffered antihypertensive combination.

          Comment


          • #6
            Just a historical point about ACEs. In the 60s, Squibb sent an expedition into the jungle. There they heard about a snake whose bite caused an adult to faint. Discovered due to profound drop in blood pressure. The species of snake was an Enalaprid?. Captopril was the synthesised version of the venom.
            johnep

            Comment


            • #7
              Originally posted by johnep View Post
              Just a historical point about ACEs. In the 60s, Squibb sent an expedition into the jungle. There they heard about a snake whose bite caused an adult to faint. Discovered due to profound drop in blood pressure. The species of snake was an Enalaprid?. Captopril was the synthesised version of the venom.
              johnep
              wow thats interesting! I take it Enalapril was also synthesised from that very venom?

              Comment


              • #8
                You should have been given some history of the various drugs in basic pharmacology. I very much enjoyed reading a book on the history of Aspirin.
                johnep

                Comment


                • #9
                  Verapamil derived from bee venom.

                  Comment


                  • #10
                    Look at NICE guidelines on Heart Failure

                    also, following an MI the majority of patients are discharged on ACEIs and BBlockers

                    remember BBs and ACEIs are not just used in hypertension

                    dose titration simply means increasing dose to one which is effective. Similarly dose optimisation involves titrating the dose to maximum tolerated dose - often used a lot in the treatment of CHF. Patients have better outcomes the higher the dose of eg ACEI/BB, but some patients may only tolerated a low dose, for example a cardiologist may wish a HF patient to be on bisoprolol with an aim to titrate the dose to 10mg, but if the patients pulse is in the low 50s/or 40s at a dose of 1.25mg, this would considered to be optimised, as any higher dose may lower the pulse to dangerously low levels

                    hope that helps

                    Comment

                    Working...
                    X