Mira is managing her hypertension with an ACE inhibitor. Which of the following statements stated by her indicates a need for further instruction?
A. “I should not take my pills with food.”
B. “I need to increase my intake of orange juice, bananas, and green vegetables.”
C. “I will avoid coffee, tea, and colas.”
D. “I will use salt substitutes that are not high in potassium.”
Correct Answer: B. “I need to increase my intake of orange juice, bananas, and green vegetables.”
The client needs to understand the risk of hyperkalemia and foods to eat in moderation. Hyperkalemia from ACE inhibitors is a direct result of the mechanism of action. The blockade of angiotensin II prevents the downstream secretion of aldosterone. Aldosterone causes reabsorption of sodium and, subsequently, water. Consequently, protons and potassium get secreted into the urine. Without the secretion of potassium through aldosterone, potassium can easily increase in patients on ACE inhibitors. Comorbidities that decrease kidney function or medications that cause potassium retention increases the risk of hyperkalemia.
Option A: Taking medications with food will decrease therapeutic effects of ACE inhibitors. ACE inhibitors should be taken on an empty stomach one hour before meals.
Option C: Excessive amounts of caffeine should be avoided. Research published in the American Journal of Hypertension has found that patients who drink the occasional cup could be reducing the effect of medication for lowering blood pressure.
Option D: Avoidance of salt substitutes that are high in potassium decrease the risk of hyperkalemia. people taking ACE inhibitors should avoid eating large amounts of foods high in potassium, such as bananas. Other foods high in potassium include avocados, beets, oranges and orange juice, potatoes, spinach, tomatoes and tomato sauce, as well as salt substitutes.