If a patient's serum creatinine increases by 25% but their blood pressure remains at goal on enalapril, what is the appropriate action?

Continuing the current dose of enalapril is appropriate in this scenario, as a 25% increase in serum creatinine can often be an expected effect of starting or continuing an ACE inhibitor like enalapril. In patients with chronic kidney disease or those at risk for renal impairment, changes in serum creatinine can occur without necessarily indicating that the medication should be altered, especially if the patient's blood pressure remains well controlled.

Enalapril is beneficial for cardiovascular health and can also provide renal protection, particularly in diabetic patients or those with hypertension and chronic kidney disease. The key point here is that the patient has maintained target blood pressure levels, which suggests that enalapril is effectively managing their hypertension. As long as the increase in serum creatinine is within a reasonable range and there are no significant changes in kidney function, it is acceptable to continue the current therapeutic regimen.

Monitoring kidney function periodically is crucial to ensure that the patient does not develop significant renal impairment, but an isolated increase in creatinine, especially one that is not substantial, does not necessitate a change in treatment.