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When combined with other antihypertensive agentsadditive falls in blood pressure may occurConcomitant use of glyceryl trinitrate and other nitrates or other vasodilators may further reduce the blood pressure.
Some hypertensive patients with no apparent pre-existing renal disease have developed usually minor and transient increases in blood urea and serum creatinine when lisinopril has been given concomitantly with a diuretic.
Symptomatic hypotension is rarely seen in uncomplicated hypertensive patientsbut is more likely to occur if the patient has been volume-depletede.gby diuretic therapydietary salt restrictiondialysisdiarrhoea or vomitingor has severe renin-dependant hypertensionsee sections 4.5 and 4.8Regular determination of serum electrolytes should be performed at appropriate intervals in such patientsIn patients at increased risk of symptomatic hypotensioninitiation of therapy and dose adjustment should be monitored under close medical supervisionParticular consideration applies to patients with ischaemic heart or cerebrovascular diseasebecause an excessive fall in blood pressure could result in a myocardial infarction or cerebrovascular accident.
CommentsMay increase dose every 2 to 3 weeksIf blood pressure is controlled with monotherapy hydrochlorothiazide 25 mg per daybut significant potassium loss occursthen similar or greater blood pressure control without electrolyte disturbance may be achieved with hydrochlorothiazide 12.5 mg-lisinopril 10 mg orally once a day.
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