Time to Action of ACE Inhibitors, ARB II, and Calcium Channel Blockers in Arterial Hypertension

Patient Evaluation and Monitoring

• The American Heart Association recommends that renal function and potassium levels should be evaluated within 1 to 2 weeks after starting treatment with ACE inhibitors or ARB II 1
• Blood pressure, including postural changes, should be reevaluated within 1 to 2 weeks after starting treatment with ARB II 2
• The American Heart Association suggests that the treatment with ACE inhibitors or ARB II should be initiated with low doses, followed by gradual increments if the lower doses have been well tolerated 1

Special Patient Populations

• The American Academy of Pediatrics notes that African American patients may not have as robust a response to ACE inhibitors, requiring higher initial doses or consideration of starting with a thiazide diuretic or a calcium channel blocker 3

Treatment Considerations

• The American Heart Association recommends that patients at high risk should be closely monitored for at least 6 hours after the first dose of ACE inhibitors or ARB II 1
• The abrupt withdrawal of treatment with an ACE inhibitor can lead to clinical deterioration and should be avoided 1