What should be done if a patient experiences symptomatic hypotension or uncontrolled hyperkalemia while taking ACEi or ARB medications?
The dose of ACEi or ARBs should be reduced or discontinued in patients with hyperkalemia after other measures have failed to achieve a normal serum potassium level. In general, similar efforts should be made to discontinue other concurrent BP medications before attempting to reduce the dose of ACEi or ARBs in patients who experience symptomatic hypotension and has a specific indication for RASi, such as severely increased albuminuria or heart failure. Which BP medication to discontinue or which ones to retain would depend on the relative indication of each medication. When these drugs are used in patients with eGFR <30 ml/min, close monitoring of serum potassium is required.