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Clinical trial data has shown that dual blockade of the renin-angiotensin-aldosterone system (RAAS) through the combined zestoretic generico of ACE-inhibitors.angiotensin II receptor blockers or aliskiren is associated with a higher frequency of adverse events such as hypotension.hyperkalaemia and decreased renal function (including acute renal failure) compared to the use of a single RAAS-acting agent (see sections 4.3.4.4 and 5.1).

As with other ACE inhibitors.lisinopril may be less effective in lowering blood pressure in black patients than in non-black patients.possibly because of a higher prevalence of low-renin states in the black hypertensive population.

High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults).and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.

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Thiazides may decrease urinary calcium excretion and may cause intermittent and slight elevation of serum calciumMarked hypercalcaemia may be evidence of hidden hyperparathyroidismThiazides should be discontinued before carrying out tests for parathyroid function.

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Concomitant use of certain anaesthetic medicinal productstricyclic antidepressants and antipsychotics with ACE inhibitors may result in further lowering of blood pressuresee section 4.4

The use of lisinopril/hydrochlorothiazide is not indicated in patients requiring dialysis for renal failure.

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As with other antihypertensiveslisinopril/hydrochlorothiazide combination products may have a mild to moderate influence on the ability to drive and use machinesEspecially at the start of the treatment or when the dose is modifiedand also when used in combination with alcoholbut these affects depend on the individual’s susceptibility

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This is more likely to occur in patients with pre-existing renal impairmentDosage reduction and/or discontinuation of the diuretic and/or lisinopril may be required.

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