initiating

• may cause significant drop in eFGR and increase K+ and Cr

  • monitor 1-2 weeks after initiation or change

  • mild hyperkalaemia not indication to stop ACEi

  • fall in GFR stabilise to \<15% from baseline (or 20% increase in serum creatinine)

  • if no other cause = reduce dose

• renal artery stenosis requiring intervention = rare

• where rises rapidly (doubling) consider urgen referral

ARB

• Candesartan vs. losartan

  • slightly improved BP with candesartan

    • not thought to be clinically signifiant

    • 4mmhg systolic

  • losartan also lowers uric acid