Another belief is that ACE inhibitors
and β-blocker therapies must be
decreased or discontinued or should
not be initiated when the patient’s
blood pressure is low. These agents
help suppress maladaptive neuroendocrine
responses that lead to
increased wall stress, ventricular
hypertrophy, and worsening cardiac
remodeling and cardiac output.51
Unless symptomatic low blood pressure
occurs or intravenous vasodilator
agents are used, core oral
therapies used to manage patients
with chronic heart failure should be
maintained whenever possible.
Blood pressure may not decrease or
the reduction may be self-limiting
when vasodilator (ACE inhibitor or
angiotensin-receptor blocker) and
β-blocker therapies are initiated and
maintained in patients with a low
baseline blood pressure (85-90 mmHg). If blood pressure decreases but
indications of hypoperfusion are
absent, nurses should assess patients
for hypovolemia (from overdiuresis).
In addition, nurses must communicate
expected effects of core agents
for treating heart failure to patients
so that patients are prepared for
potential dizziness or other symptoms
associated with drug actions
and interactions and understand the
self-limiting nature of these changes