n cost is a factor, does it make sense to add a generic ACE inhibitor for improved hypertension control? The patient is a 67-year-old woman prone to hypokalemia. Her current regimen includes an angiotensin receptor blocker (ARB) and a beta blocker. Maximizing the dosage of the ARB doubles the cost.
—Helene DiSantos Ormond Beach, Fla.
oretically, it is safe to use an ACE inhibitor with an ARB, but it would be better to stick to one or two drugs at adequate doses. Have you tried a generic diuretic, such as hydrochlorothiazide with a generic ACE inhibitor (e.g., lisinopril)? This combination may prevent trouble with low potassium. Alternatively, try a potassium-sparing diuretic or generic calcium channel blocker (not with the beta blocker, of course). You are to be commended for paying attention to the cost of your patient’s pills, which will improve her chances of sticking with therapy.
—Rueben W. Zimmerman, PA-C (106-15)