You may have a dry cough. This may go away after a while. It also may start after you have been taking the medicine for some time. Tell your provider if you develop a cough. Sometimes reducing your dose helps. But sometimes, your provider will switch you to a different medicine.
DO NOT lower your dose without talking with your provider first. You may feel dizzy or lightheaded when you start taking these medicines, or if your provider increases your dose. Standing up slowly from a chair or your bed may help. If you have a fainting spell, call your provider right away. If your tongue or lips swell, call your provider right away, or go to the emergency room. You may be having a serious allergic reaction to the medicine. This is very rare. Call your provider if you are having any of the side effects listed above.
Also call your provider if you are having any other unusual symptoms. Mann DL. Management of heart failure with reduced ejection fraction. Philadelphia, PA: Elsevier Saunders; chap J Am Coll Cardiol. PMID: www.
Updated by: Michael A. Editorial team. ACE inhibitors. How ACE inhibitors help. Types of ACE inhibitors. Taking Your ACE inhibitors. In addition: Try to take your medicines at the same time each day. DO NOT stop taking your medicines without talking to your provider first. Plan ahead so that you do not run out of medicine.
Make sure you have enough with you when you travel.
Before taking ibuprofen Advil, Motrin or aspirin, talk to your provider. NAWA stethoscopes were used. There was no statistical difference according to sex or age in the two study groups Table 1.
Only the patients followed up at FHP units had nursing consultations, group activities or home visits Table 3. There were no statistical differences in relation to monotherapy, use of two drugs or use of more than two drugs, among the groups followed up at PHUs and FHP units Table 4. There was also no statistical difference regarding classes of antihypertensive drugs, either in monotherapy or in associations Table 5. We observed in our study that the proportion of the patients with blood pressure that was under control at the last consultation at the FHP units was Although the observed percentage control was unsatisfactory, it was similar to what has been described in the literature.
We observed that the blood pressure control was better among the men studied at PHUs. However, we were unable to explain this finding, taking into account the size of the sample. The attendance model proposed for the FHP aims towards health promotion through team actions relating to quality of life, with interventions applied to factors that place this quality of life at risk. This is to be achieved through knowing the clientele better, not only at the units but also in their homes, and through detecting these people's real needs and encouraging them to recognize that their health and quality of life are citizens' rights.
With this model in mind, it was expected that when the HiperDia program was implemented within SUS, the FHP units would be more effective in controlling blood pressure, compared with the traditional model of the PHUs. The teams at PHUs are not multidisciplinary and they act only in the PHUs: there are no consultations at patients' homes and no active searches for missing patients are conducted.
However, what we found was that the blood pressure control at the FHP units was inferior to the control achieved at the traditional PHUs. Our study compared populations that were very similar, formed by individuals who sought primary healthcare through SUS and who therefore were of comparable socioeconomic level. Furthermore, the groups were similar in terms of gender and age distribution. The medications provided are supplied by the city health authorities and the state government.
The HiperDia manual, containing guidance relating to diagnosing and managing high blood pressure, was available at all the units evaluated.
With regard to the medical professionals working in the two types of unit, we observed that they presented different characteristics, such as the length of time since graduation and the different specialties represented. Differences in specialties lead to the hypothesis that the results encountered might have been influenced by this factor, but in this respect, not only the physicians' original training but also their continuing training would have to be taken into account.
Davis and Taylor-Vaisey 10 suggested that continuing education among physicians leads to better performance in relation to treatment for cardiovascular disease and in relation to dealing with its risk factors. Schneider et al. Data from the Brazilian Ministry of Health 13 published in showed that between and , the introductory training provided by the ministry, which ought to be given before or immediately after setting up the teams at the FHP units, reached averages of Specific training for these teams in relation to managing hypertension reached averages of only In the State of Rio de Janeiro, these averages went up to Continuing healthcare education has been provided over this period, with material from the Ministry of Health and delivery by professionals from within the public healthcare system.
Most of the physicians working in the nine PHUs of the municipality had been trained in internal medicine. We observed that the larger number of consultations that took place at the FHP units, in relation to the number of consultations at PHUs, was not reflected in better control over hypertension. We suspect that both the quality of the consultation and the physicians' training were factors that may have influenced the results.
Haynes demonstrated that despite the known need for adherence to treatment in order to control high blood pressure, there was great difficulty in achieving this. Several models have been tested with a view to improving the adherence to treatment for chronic diseases. Another important point regarding adherence to treatment for these diseases relates to the drugs used and their prescription.
A meta-analysis conducted by Schroeder, 17 in which drugs administered once or twice a day were tested, showed a single study in which a decrease of 6 mmHg in systolic pressure, with important repercussions on diastolic pressure, was found with the use of drugs taken once a day. Data from the Primary Care Department 18 have shown that the drugs most used within HiperDia are ACE angiotensin-converting enzyme inhibitors, diuretics and beta blockers. In our study, the type of monotherapy most used was ACE inhibitors and the combination most used was ACE inhibitors with diuretics.
However, the monotherapy did not show better blood pressure control, considering that the ACE inhibitor used was captopril, which has to be taken as at least three doses per day. Our study presents certain limitations, given that the data were extracted from the medical files. Moreover, although both types of unit took their guidance from the HiperDia program, both for measuring blood pressure and for diagnosing hypertension and treating it, the blood pressure measurements were performed by different people and we cannot be absolutely sure that the diagnostic criteria and case management were followed equally in the two groups.
The results show that the level of hypertension control in both types of unit is still unsatisfactory. New studies are needed in order to identify the possible obstacles that may be influencing these results. Global burden of hypertension: analysis of worldwide data. Mortalidade - Brasil.
Accessed in Oct 7. J Bras Med.
Are you sure? Ten ACE inhibitors presently approved for use in the United States work by competitive inhibition of angiotensin-converting enzymes. Stamford, Conn. Earn up to 6 CME credits per issue. Z Arztl Fortbild Qualitatssich. Our study presents certain limitations, given that the data were extracted from the medical files.
Arq Bras Cardiol. Accessed in Aug Vassar stats: website for statistical computation. Accessed in May Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. Z Arztl Fortbild Qualitatssich. J Hypertens. Interventions for helping patients to follow prescriptions for medications.