When should ACE inhibitors be used cautiously in patients with AMI?
ACE inhibitors should be used cautiously in the first 24 hours of AMI, because it may result in hypotension or renal dysfunction. It may be prudent to initially use a short-acting ACE inhibitor, such as captopril or enalapril, in patients at increased risk of these adverse events. In patients with significant renal dysfunction, it is sensible to stabilize renal function before initiating an ACE inhibitor or an ARB, with re-evaluation of creatinine levels after drug initiation.