title: Profound hypotension in a tetraplegic patient following angiotensin-converting enzyme inhibitor lisinopril. Case report.
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 was 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.
authors.affiliation: Department of Internal Medicine, Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, Virginia 23249.
authors.forename: J K
authors.initials: JK
authors.lastname: Schmitt
authors.forename: K S
authors.initials: KS
authors.lastname: Koch
authors.forename: M
authors.initials: M
authors.lastname: Midha
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000150:complications; D017706:Lisinopril / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011782:Quadriplegia / Q000150:complications*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017706:Lisinopril