Medicine Hack

No guidelines have suggested that Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) can be given together. Yet in practice, well i should say malpractice, many doctors do prescribe both simultaneously. This is not good at all since recent trials have shown that using both together doubles the risk of hyperkalemia and doubles the level of creatinine and risk of developing ESRD within 6 months of bi therapy.

This phenomenon has not been given its due importance. Many of us surely know the term 'White Coat Hypertension'. The latter refers to an increase of up to 20 mm Hg in the systolic blood pressure of the patient if a doctor is taking the B.P measurement. 'White Cap' actually refers to the cap of the nurses. It was compulsory in the 1980s and still worn in many settings. It was seen that when nurses take the B.P then also there was an increase of up to 10 mm Hg of the systolic blood pressure compared to a home setting. Since in our setting it is the nurse who takes the B.P measurement, then the above named term is more appropriate. Also another conclusion from this is that doctors are scarier than nurses. :-)