BRITISH HYPERTENSION SOCIETY GUIDELINES
EDITOR - In their summary of the British Hypertension Society
guidelines, Ramsey et al(1) include a table
purporting to list compelling and possible contraindications for the major
classes of antihypertensive drugs. It was disappointing to find no mention
therein of Lithium vis a vis thiazides and ACE Inhibitors. Thiazides are
well recognised in this regard and, in most non-specialists appear
cognisant of the dangers of concurrent administration with lithium.
Sadly this does not apply with regard to the potentially lethal
combination of Lithium and ACE Inhibitors (2).
One is, therefore, mindful of the need to maximise awareness of this
interaction, given the apparent increase in prescribing of ACE Inhibitors
outside of specialist clinics.
Perhaps within the full guidelines(3), mention of Bipolar Disorder
treated with Lithium as a special group, would
be warranted, given the interactions noted above and the potential of
certain Calcium Antagonists (Verapamil
and Diltiazem )to cause neurotoxicity in concert with lithium, in the
absence of raised blood lithium levels.
1.RAMSEY et al,BRITISH HYPERTENSION GUIDELINES...SUMMARY.
2.BRITISH NATIONAL FORMULARY.MARCH 1999;37:585.
3.RAMSEY et al, GUIDELINES FOR MANAGEMENT OF HYPERTENSION...1999. J
HUM HYPERTENS 1999;13:569-92.
DR. G. DRYBALA. CONSULTANT PSYCHIATRIST.
BRANDON PSYCHIATRIC UNIT.LEICESTER. LE5 4PW.
Competing interests: No competing interests