Abstract
We present the case of a 60 year old C6 complete tetraplegic patient who developed profound hypotension following initiation of the angiotensin-converting enzyme inhibitor lisinopril to control blood pressure. Other causes of hypotension, such as myocardial infarction and sepsis were ruled out. Inhibition of the renin-angiotensin-aldosterone system was the probable cause of hypotension. This case demonstrates the critical importance of the renin-angiotensin-aldosterone axis in the maintenance of blood pressure in tetraplegic patients, who may lack input from the brain to sympathetic neurons, and therefore have increased reliance on the renin-angiotensin-aldosterone axis for the maintenance of blood pressure. Angiotensin-converting enzyme inhibitors should be avoided in tetraplegic patients, unless other treatment modalities are ineffective.
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This paper was presented in part at the 20th Annual meeting of The American Spinal Injury Association, Philadelphia, PA, April 25-27, 1994
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Schmitt, J., Koch, K. & Midha, M. Profound hypotension in a tetraplegic patient following angiotensin-converting enzyme inhibitor lisinopril. Case report. Spinal Cord 32, 871–874 (1994). https://doi.org/10.1038/sc.1994.133
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DOI: https://doi.org/10.1038/sc.1994.133