A hypertensive patient with a creatinine of 1.9 mg/dL is currently taking a diruetic, calcium channel blocker, and nitrate. At what level is creatinine considered a contraindication to placing a patient on an ACE inhibitor or angiotensin II receptor blocker (ARB)? — Linda O. Lathan, RN, MSN, CCRN, FNP-C, Wilson, N.C.

ACE inhibitors and ARBs are contraindicated in a patient whose serum creatinine is 30% or more above desired levels. Assuming an upper level of normal of 1.2mg/dL, the patient described is more than 50% elevated, making the choice of the ACE inhibitor or ARB inappropriate. — Sherril Sego, FNP-C, DNP (151-8)

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