Increase in creatinine upon initiating ACE inhibitors
You start a lisinopril in a patient and it worked well for the patient and brings her BP to your goal. However, her creatinine rises from 1.25 to 1.5.
What should you do? Continue the current medication.
“ACE inhibitors such as lisinopril do not need to be discontinued unless baseline creatinine increases by >30%. Small increases in creatinine have been associated with long-term preservation of renal function and may be a marker of changes in intraglomerular pressure.” ABFM
“Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy.” AHA Journals
Reference
Am Fam Physician 2012;85(9):883-889.
Arch Intern Med 2000;160(5):685-693.
https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.118.12060