Poor response to ACE inhibitors

NICE guidelines for treating hypertension

Hypertension was identified, and a CV screen was offered to enhance the NMS experience.

This male patient presented with peripheral BP of 174/114, cBP 170/116 and AI 124%.

He was prescribed Ramipril 10mg.


NICE guidelines for treating hypertension

On day 7, the AI improved dramatically due to the Ramipril, but the BP remained resistant.

The pulse pressure (marker for stroke risk) improved as well = closer to the ideal of 40mmHg.

However, after 14 days, the BP still remained resistant and the patient was referred back to his GP. The GP decided to pursue with the Ramipril 10mg for two months.


NICE guidelines for treating hypertension

After 6 weeks, the BP is still resistant, and the patient decided to go back to the GP as he is also booked in for a blood test. (We are waiting for the GP’s response)

The patient received lifestyle advice and has already lost 2kg in weight and tries to exercise regularly. We found that residual effects of exercise are often evident after 3 months of regular exercise.


This is another example of how the pharmacy can engage with and help the patient to understand his/her condition and confirm the results of treatment to the GP.