Which of the following medications should not be increased simultaneously with ACE-I/ARB due to hypotension risk?

The risk of hypotension is a significant consideration when adjusting medication dosages, particularly in patients with heart failure. Beta-blockers are crucial in the management of heart failure and are often used in conjunction with ACE inhibitors or ARBs (Angiotensin Receptor Blockers).

When the dosages of ACE inhibitors or ARBs are increased, it can lead to enhanced vasodilation, which may lower blood pressure. If beta-blockers are also increased at this time, there is a compounded effect that can excessively lower blood pressure, leading to hypotension. This risk is particularly important in patients who may already be experiencing low blood pressure due to heart failure or those who are particularly sensitive to fluctuations in blood pressure.

In contrast, while digoxin, amlodipine, and anticoagulants play important roles in heart failure management and treatment of associated conditions, they do not carry the same immediate risk of inducing hypotension when their doses are increased alongside ACE inhibitors or ARBs. For instance, digoxin primarily works by increasing the force of myocardial contractions rather than significantly affecting vascular tone, and amlodipine is a calcium channel blocker that can also be used but has a different mechanism of action.

Thus, it is critical for clinicians to be mindful