Ramapril and High BP

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I have been using Ramipril for several months now and have gone through all of the usual side effects. My BP currently varies between 110/55 up to 195/95. For the past 6 months my GP's have been conducting trials having been taken off Bendrofloumethiazide.  I am taking 10mg at 2200 every night and the daily BP readings have stabilised to about 125/60 when I wake up at about 0730 and generlly drop to about 110 during the morning. Then start to rise after 1100 and by 1400 are about 130/65. This rise continues steadily to about 170/75 until I am ready to take my nightime dose. 

To help control the evening BP we are currently trying Candesartin 8mg twice a day but with little apparent effect.

To me, it appears that the Ramipril dosage is too small to cover the full day. After studying several websites there appears to be two trains of thought:

(1) Ramipril as a Preventative

(2) Ramipril for Hypertension

The max dosage appears to be 10mg when used as a preventative but when used for BP I get conflicting advice. Some say 10 max and others say 20 max for Hypertension use.

If the latter is correct then we have a suggested course of action - up the doage slightly. However, my GP's and pharmasist appear not to accept the higher dosage advice. Indeed, they are now beginning to argue among themselves about the use of both Ramipril and Candesartin together! 

I am used to the side effects now and just want my BP back under control. Has anyone else come across this 'Out of Control' feeling?

DCCDave

 

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  • Posted

    DCCDave...I can understand why the argument about the use of both Rampiril & Candesartan. Rampiril is in the class of ACE Inhibitors, while Candesartan is in the class of ARB. While both work on the same principle, there is a little difference between the two; something about salts, etc. Here in Canada doctors were directed by Health Canada a few years ago NOT to prescribe both to patients, for risk of lowering the blood pressure too much. If your pharmacist is the one arguing about not taking both together, according to what we do here, I'd be inclined to believe him/her, as after all, they are the ones who specialize in medications.

    Let us know how you get on with this.

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    • Posted

      Hi Mike, Thank you for the comment. I miss the reliability of having just one GP to go to. These Practices are alright for one offs in my humble opinion are not for the long haul where 'history' is all important. Several different people will have different takes on the same data provided to them. 

      It is 2240 here now, I have taken my medication and my BP is 189/80 but going down! I do not feel any different. The nearest we got to stabilisation was a couple of months ago when we tried Felodipine 5mg am and 5mg pm with the Ramipri.  That at least got the pm BP down to around the 150/65 mark.

      Looks like we will be going around the buoy again!

      Dave

       

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    • Posted

      DCCDave..do you not have a regular GP? You are so right when you say history is so important. Several months ago I left the Dr I had here because he was not a good fit for me. He's young & very cocky..a know-it-all as well. He'd barely speak with you when he entered the exam room & went straight to the computer. Half the time I didn't know if he was listening to me. I feel that if I stayed with him, eventually I'd be very ill so I made enquiries with my former Dr about returning to his practise. Fortunately he said he was willing to take me back & to set up an appt with the receptionist. My biggest mistake was leaving him in the first place but I wanted to avoid the hour or so long drive. We get along famously, I'm very at ease with him & have complete faith & trust in him, not something that was even close with the young one. 

      Im sure you know that Felodipine is in the class of calcium channel blockers as is Amlodipine. You certainly can take Felodipine with Rampiril if the Dr will give it to you. They do not clash. 

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    • Posted

      Hi Mike,

      I am fully expecting a case review - in absentia! I may well have to suggest that we go back to the Felodipine and Ramipril mix for a retrial. It is the lack of continuity that gets to me these days. I am not against the new technologies being introduced and we all have to learn. It is just so frustrating having to tell the same story to a different Doctor every time I visit the practice. It is a little like asking for a second opinion gone wild!

      Dave

       

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  • Posted

    I was put on Ramipril for high blood pressure when my stable bp readings were around 160 systolic.

    ?I was told by my surgery that I was ill, that I couldn't control my blood pressure myself and that I needed to get my bp down to 150 systolic (that was the old WHO target 10 years ago).

    After a few weeks on the drug the hypertensive clinic measured my bp as 180/80 and the nurse couldn't explain this unexpected result.  I reported that I had collapsed on the ground, breathless whilst walking my dog in the wood. I was told to accept the side effects and get on with it.

    ?After a few months I developed multiple adverse effects to the stage where I was having difficulty in breathing at night and eventually had a sudden onset of mucous discharge and had to desperately clear my airway  by pulling it out manually over the toilet.

    ?The only thing that fitted my symptoms was Drug Induced Angioedema.

    The surgery denied that this ever happened on the basis that this only occured in 1  a million cases.

    ?What follows is another story.

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    • Posted

      Hi Bob, Thanks for sharing. 1 in a million so why not? I am reminded of what I was told many yers ago about the accuracy of things:

      Lies, Damn Lies and Statistics! in that order. I feel worse now that they have tampered with my body's attempts to control the BP than when it was left alone. At least then, I did not get breathless and could not feel the effects of the altering BP on my body. I felt happier and a lot better in myself.

      Dave

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    • Posted

      Hi Dave,

      ?Sorry to hear you feel worse after being 'tampered' with Ramipril.

      ?I am a retired research professional having worked in the field of human factors for over thirty years. I fully understand your observation about accuracy because my job relied on assessing the strain that people were put under when using my firm's products.

      ?Health techology has now become cheap enough to show medical professionals exactly what their prescriptions are doing to people.

      ?I've found that doctors are not comfortable about discussing instrumental reports from devices they don't use or understand and find it easier to withold their patients' medical records and ignore results from patients' own observations.

      ?At least my GP's surgery has come to the conclusion that average home blood pressure monitoring may be better than a single 'office' reading.

      ?It's still not good enough because there is evidence that BP readings, however they are taken, result in a cardiovascular response which invalidates the readings - i.e. your measured blood pressure goes up!

      ?Bob

       

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    • Posted

      Hi Bob,

      This trial, for want of a better phrase, has been on going for over 6 months now. I have a good quality home BP monitor and have been taking three readings, about a minute apart, every morning when I get up and in the evening before I go to bed. These are averaged out and the results noted in tabular form so that the GP can see the trends as they occur. I also note any outside influence too, like having a bad cold to contend with.

      I had to stay in overnight after an eye operation a few weeks ago and was on constant monitoring because I also suffer from OSA. The readings confirmed what I was already getting and as stated in my original post. The morning readings have been forced down to around 130/60 and these dropped to around 110/50 during the morning and then start to rise back up to 140/65 during the afternoon and continue up towards 180/80 in the evening just prior to taking the Ramipril again.

      I have just measured my BP again at 138/65 before taking the afternoon dose of Candesartin 8mg. All it appears to be doing is make me feel tired and a little unsteady on my feet during the afternoon.

      Dave

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    • Posted

      Hi Dave,

      ?After my experiences with Ramipril and my body's rejection of it, I was determined to find a rational explanation for what had been happening to me.

      ?After my spell of freedom from drugs, my GP's surgery caught up with me and having written to my GP saying that I was opting for a health style approach to BP control, the surgery manager told me that I would be taking drugs to control my BP.

      ?Unfortunately, I hadn't realised how important drug compliance was in the medical profession and as far as I was concerned I had no option but to comply. (After all, one patient who asked to see their notes resulted in the police being called)

      ?So I embarked on another session of being prescribed bp lowering drugs - but this time the WHO target had dropped to 140 mmHg systolic!

      ?However, I had already purchased a recording pulse oximeter to track my blood oxygen saturation for the natural breathing approach to bp control.

      Whilst observing my SpO2 I noticed that my blood O2 saturation was falling during treatment. An OSA whilst taking any medication that compromises your airway is dangerous and even more so if you are taking anything that acts as a central nervous system suppressant.

      Bob

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  • Posted

    Time for an Update - I have now been on a combination of Ramipril 10mg and Amlodipine 10mg for four weeks having moved up from 5mg Amlodipine. Allowing for the fact that most medication takes effect over a period of up to 10 days I find myself right back where I started from several months ago when on Felodipine 5mg. The BP have stabilised down to the 120's/60's in the morning but rising to the 150's/60's in the evening yet the evening readings remain stubbonly higher that expected.

    I am about to see the Dr shortly to see where we go from here since I am on the top dosage of both drugs. Whilst on the Felodipine it was never raised to 10mg but instead was changed to Candesartan but that proved to be a bust also.

    Is anyone else out there on such a high dosage?

     

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    • Posted

      DCCDave...Here in Canada, Drs do not prescribe an ACE & an ARB together. This directive came down from Health Canada. They found tht prescribing both lowered bp far too much/quickly, so patients are either prescribed one or the other. Rampiril is in the class of ACE Inhibitors. You're also on Amlodipine which as you might know is a Calcium Channel Blocker. Both are just fine together. Your bp is spiking in the evening...why not take 1/2 of the Amlodipine in the morning, then the other 1/2 at night? My cousin was on 5mg Amlodipine for quite a while, then found her bp spiking in the afternoon, so her Dr. suggested what I just did to you. Bingo!...it worked.

      Actually, 10mg Amlodipine is the highest, but it's not sky-high by any means. If you're at the top with Rampiril, you could ask the Dr. to try you on Perindopril..or Coversyl. There is Coversyl Plus..but that has a diuretic in it, so if you want to ask about this be sure to suggest the plain Coversyl. 

      The Candesartan you were taking is in the ARB class of medications..yet the Felodipine was never raised to 10mg. This is perhaps why there was no change?

      Anyway..please let us know how you get on with this.

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    • Posted

      Hi Mike,

      I am on to my 7th GP in the practice so far and will be asking the question regarding changing back to Felodipine and upping the dosage to 10mg. I have tried the split dosage method previously but all that did was to really drop the morning BP down too low for my liking. At present the Ramipril gets taken at night and the Amlodipine at about 1600 but this does not appear to be dragging the evening BP's down to an acceptable level.

      Dave

       

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