You get a phone call from the heart failure nurse specialist regarding a patient followed up in clinic for titration of medication. He has dilated cardiomyopathy with an EF of 30%. His most recent BP is 110/60 mmHg with heart rate 60 bpm. He is currently on bisoprolol 7.5 mg od and ramipril 5 mg od. His renal function test results have been phoned through to the specialist nurse:
(Baseline before titration of ACE inhibitor: Na 138 mmol/L, K 4.8 mmol/L, urea 8 mmol/L, creatinine 180 µmol/L.)
What would be your advice?
A. Continue current medication and recheck U&E at 1 weekESC Guidelines suggest that if creatinine is 265–310 µmol/L or K+ >5.5 mmol/L the dose of ACE inhibitor should be halved and blood chemistry should be monitored closely.