Although a diuretic may be added to a patient on an ACE inhibitor, the practitioner must be cautious when starting an ACE inhibitor in patients already taking diuretics.
Hypotension, particularly with the first dose, and the risk of dangerous hyperkalaemia in patients taking potassium sparing diuretics has lead to the general recommendation that therapy be started in hospital.
Suitable patients with uncomplicated mild to moderate heart failure can be treated in general practice if they are very carefully supervised:
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