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- lisinopril (start at 5mg daily, usual maintenance 20mg) or perindopril erbumine if first dose hypotension an issue (start at 2 to 4mg daily).
- if intolerant of ACE inhibitor consider angiotensin-II receptor antagonist.
- issue ‘Sick Day Rule’ card.
- check U&Es 1 to 2 weeks after starting/dose increase. Monitor annually if stable.
- avoid the combination of ACE inhibitor and angiotensin-II receptor antagonist.
- use caution when combining ACE inhibitors or angiotensin-II receptor antagonists with spironolactone due to risk of hyperkalaemia.
Beta-blocker therapy: may be indicated as first-line therapy in ischaemic heart disease.
Primary prevention: if diabetes or 10 year risk of CVD is 20% or more, or a strong family history of premature vascular disease, recommend lipid-regulating therapies; see guidance and the ASSIGN score at http://assign-score.com.
Antiplatelet drugs (aspirin and clopidogrel): use in secondary prevention only (ensure continued if vascular disease is present).