From the Research
ACE inhibitors or ARBs should be used with caution in patients with Addison's disease, and only when necessary for treating conditions like hypertension or heart failure, with careful monitoring of blood pressure and serum potassium levels, as recommended by the most recent study 1.
Key Considerations
- Patients with Addison's disease are already at risk for hypotension due to inadequate cortisol and aldosterone production, and ACE inhibitors/ARBs can further lower blood pressure by blocking the renin-angiotensin-aldosterone system.
- Ensuring adequate glucocorticoid and mineralocorticoid replacement therapy is essential before starting these medications.
- The treatment of choice for hypertension in Addison's disease is an angiotensin II receptor antagonist or angiotensin converting enzyme (ACE) inhibitor, with the fludrocortisone dose remaining unchanged, as stated in the study 1.
Monitoring and Education
- Regular monitoring of blood pressure and serum potassium levels should occur initially weekly, then monthly once stable.
- Patients should be educated about symptoms of hypotension (dizziness, lightheadedness) and when to seek medical attention.
Alternative Options
- Dihydropyridine calcium channel blockers are clinically useful as second line agents, but diuretics should be avoided, as mentioned in the study 1.
- In the setting of heart failure, loop diuretics may be used, but not aldosterone antagonists such as spironolactone or eplerenone, as recommended by the study 1.