Ramipril and Imigran - incompatible?

I tend to agree with you as my BP varies a lot and as HH and GERD/Acid Reflux cause cheat pain and symptoms similar to cardiac problems it may be affecting my BP.

I will try this on the consultant I am seeing at the hypertension clinic at my next appointment. Actually I don't think I mentioned to him that I have HH and GERD.

Thanks  Kevin - I will ask about HH when I next see my doctor - I may have this problem, too, although it does not cause pain.

Hi - I don't know yet whether I will suffer from migraines on this medication, but I suspect I will 😪.  Nice to know that if I do, then there is an alternative in Losartan.

Thanks Derek - I'll check out Rxlist!

They are both cheap and almost the same price to the NHS.

 

So why then is Ramipril always the first line?

Ramipril is an Ace Inhibitor and Losartan  is an angiotensin II receptor.

The Doctor must think that one family of drugs is the more suitable for you...........or else the coin came down on that side:-)

I did know the technical difference between the two but they both apparently do exactly the same thing don't they - unlike calcium channel blockers and diuretics, neither of which I've taken but I understand they aproach the problem from a different angle. Am I right or not?

Taken from Wikipedia:

"An ACE inhibitor (or angiotensin-converting-enzyme inhibitor) is a pharmaceutical drug used primarily for the treatment of hypertension (elevated blood pressure) and congestive heart failure (CHF).

This group of drugs cause relaxation of blood vessels, as well as a decreased blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart. They inhibit the angiotensin-converting enzyme, an important component of the renin-angiotensin-aldosterone system."

"Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs), AT1-receptor antagonists or sartans, are a group of pharmaceuticals that modulate the renin-angiotensin-aldosterone system. Their main uses are in the treatment of hypertension (high blood pressure), diabetic nephropathy (kidney damage due to diabetes) and congestive heart failure"

 Calcium channel blockers with a diuretic were regarded as the standard initial treatment for BP but it seems that newer drug options are now preferred.  

Think I'm getting to old to get my head round that lot!

I'd done enough research at diagnosis to know that I wouldn't be able to eat my beloved grapefruit for breakfast if I took Amlodipine which my original dr wanted to put me on; he was quite sweeping when I said I'd like to try and sort it by exercise and life style. "You'll never manage it" he said, althoug he did give me a month's grace..Almost immediately when put on the initial ditsy dose of Ramipril it started to work although they increased the dose a month later and the cough started. My research also told me that Ace inhibitors are not given as a first line med if you are either over 55 yrs or black. So I expected a fight but by then I had a different dr [same practice] who just accepted it and gave me Ramipril. [She even wrote in my notes that I was a 'grapefruit eater' as though it was some sort of evil drug! ]

My BP went down to normal fairly quickly but a few months later they switched to Losartan becasue of the cough. Having been on that for over a year my dr reduced the dose to the lowest possible. Now that gives me an average of 120>/75<. i'd like to ask her next time i go for a check if i could come off them all together. wonder what she'd say ?

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What highs do you get? I get lower than 120/75 at times but my highs are still sky high in the mornings.

 

Looking at the past 6 days taking 2 readings first thing and another 2 during the evening, the highest was 128/78. Like you the highest always seems to be in the morning and even when the systolic is in the 120s the diastolic is mostly 80>. This is on 25mg Losartan.

It was 160/93 after a 24hr monitor at diagnosis just over 18 mths ago.   I was wrong when I said earlier that the dr had said "You'll never manage it" when I asked to try and sort it on my own. What he actually said was "You won't be able to make enough difference". I worked on it very hard,really out of sheer cussedness, I  lost a lot of weight although wasn't very overweight before, reduced my alcohol intake, gave up salt, took up exercise all the time taking the tablets. I do so hate taking medication.

 When last I visited the dr I was offered a statin just because the qrisk was 14%.  First thing I asked was would she take one herself, all things being equal and she said 'NO' - emphatically. The fact is that the qrisk goes up each birthday and also if you are on BP meds even if the actual number is optimum. Stupid isn't it - after all it's only a 'risk'. Anyway if she wouldn't take a statin then I certainly wasn't going to either.

Incidentally do you know why when you fill in forms like the qrisk they only ask for the systolic number, I was under the impression the diastolic is just as important?

At 128/78 you cannot now be called hypertensive.

My highest so far this month was 209/90 and the lowest 121/61 and I take 100 mg of losartan.

My GP is probably in his mid 50's runs marathons and takes a statin.

Systolic or diastolic seems to be another minefield. I had a spell with my diastolic in the 120's and a very junior cardiology registrar said that it didn't matter.

I met a woman whose job was going round building and industrial sites doing health checks on manual workers. With BP she said that diastolic is the more important and any with diastolic over 90 she advised to see their doctor. 

Jane are you really sure you need to be on medication your numbers  seem very normal and you are on the lowest dose of meds do you think they make a difference in your reading????. up for debate I think....

I take courage from what you say Derek. I'm assuming that my now current low readings are solely down to the Losartan and if I were to stop then it would shoot back up to what it was on diagnosis. That is what I read all the time. There is no cure for hypertension I understood and it's pills for life or so I understood. All the same I think I'll ask at my next check up, perhaps as Helen suggests they are not having any effect.

Interesting what you say about your GP who takes statins.I wonder why he does. Recently a God daughter and her husband [both GPs and both 50] were staying with us when the husband said he took statins as he'd had a DNA profile done which indicated he might develop Alzheimers. I really didn't get the point of what he was saying at all but concluded drs knw more than the rest of us. Or do they - I thought statins lowered cholesterol not prevented dementia.  

Hi Helen, As I just said to Derek I was under the impression that once you were diagnosed it was for life. Which is why I  tried to sort my life style out to make a difference - plus sheer bloody mindedness!

 I do think that has worked for the most part and so far seems sustainable. Not sure which part has had the most effect but probably the walking and losing weight. My grandaughter said recently "Granny you've no bum left" as though it was something to regret not celebrate. I pointed out to her that I've had a big bum all my life so was quite happy about that!! That apart I've really no idea whether the losartan makes any difference or not. I was told to take it and I've done as I was told.

Perhaps lifestyle changes have improved your BP readings. My lifestyle was good for years before developing BP.

Some recent medical reports have said that lowered cholesterol helps prevent dementia but let me say this. My best friend was a fit nonsmoker who did hill walking with a group every weekend and local walks during the week. There did not seem much wrong with his diet except that he always ate all the skin of the chicken:-)  He had a heart rhythm problem and low BP and was fitted with a pacemaker about twenty years ago. He was then told that he would have to take Amiodarone for life. That seemed strange as his heart rate was being controlled. That gave him a serious skin condition and he stopped it. 

His BP remained low but his cholesterol was highish and he was put on a statin. He began to get muscle pains that worsened over time and the long weekend walks had to stop. Soon the walks over the local hill stopped as well. He had been looking forward to his retirement and to do more traveling but soon he hardly went out. He had on occasion in the past suffered from mild depression and now it became much worse and he was prescribed a powerful anti-depressant. Instead of having for a short time his GP left him on it and side effects from it probably worsened his condition. By then side effects from statins began to be realised but his doctor left him on them. 

His memory started to go and for the past six years dementia started to take hold. He became noisy and abusive to his wife and was doing very strange things and became incontinent and was staggering and falling a lot. Last month his wife had to put him in a nursing home for dementia patients. Now he wears a nappy and is in a wheelchair.

Did statins cause his problems?  

His wife has had hypertension for at least 25 years and stopped started on medications due to side effects. Over the past few years with the stress of his condition it had been higher than ever but she (now 83) no longer takes medications.  

This whole issue surrounding statins is minefield. I think opinions are split on this matter although many in the medical profession believe it to be a "wonder" drug!

Personally I am happy to take a low dosage as it does help to control my cholesterol. But I do have little nagging doubts about long term effects.

Something else you mentioned about your friend Derek that I found interesting was how depression played a part. I for one used to dismiss depression as a non complaint. How wrong I was!! As I have got older I know so many people, of all ages, who suffer from it. Its a real sod if it gets hold of you. I have never suffered badly from depression but do have "down days" and they are bad enough. Drugs can help but I wonder if they sometimes compound problem?

In life he had nothing to be depressed about.  Depression seems to come in many forms and can be from a chemical imbalance in the brain.

He did have one admission to hospital for it but here ageism evidently comes in to it as he was told the next time that over 70's are not admitted to psychiatric hospitals for treatment. Evidently too many of them and all deemed to have dementia or Alzheimer’s.  

i ought to add that my ife style was good before the diagnosis of BP even if my weight was always yo-yoing - it never got totallyout of hand, I just enjoy cooking and eating! However although always active, and a serious gardener, I didn't walk regularly always feeling I could use my time more productively.

However I was sorry to hear about your friend. I assume you are saying that the statins and the rest had a serious impact on him and the dr was negligent in not being aware of it. We all believe what the drs say, at least I used to but since reading so much and joining this site I have become a sceptic. Not sure if that is a good or bad thing !! One thing though that I have noticed is that drs really don't know what they are talking about when it comes to all sorts of things but mugs that we are we assume they do.

I personally feel strongly against the current feeling about administering statins to everyone.

Derek, the tragedy for your friend is that he was failed not once but twice by the medical profession.  The first time when he was left on statins in spite of muscle pain and the second when he waqs left long-term on powerful anti-depressants.  Another tragedy is that such GPs get away with it.

Who knows if it was the statins or not. I kept on blaming the statins but he and his wife followed doctors orders. Same with the SSRI he kept on being prescribed for his depression. It was only last year that his doctor stopped the SSRi saying, It's not doing him any good. I kept on telling them to change doctors. They travelled miles across town for dentists that they liked but stuck with the nearest GP.

After only two weeks in the nursing home he fell and cracked his pelvis.

He was previously very fit walking and looking after his half acre garden. Being a true Scot he ate porridge every day of his life and they were self sufficient for fruit and veg and made wine from the vine in their greenhouse..

That really is so sad and as Mrs O says such GPs get away with it. There is a saying 'Lawyers charge for their mistakes; Doctors bury them'. How true.

 

It is costing his wife £1095 a week to keep him there though there is some means tested personal  care allowance in Scotland that has yet to be sorted out plus the carers allowance.

How prices have gone up. When my mother was in a retirement home fifteen years ago it was about that a month. She timed it well as when she died there was only enough for the next months fees left in her bank account.

 

Care Home fees!!!!!!! Don't get me started. Dad spent the last 3 years of his life in a Care Home and the savings that he wanted to go to mum had to be spent on his care (means tested) Total cost? £92,000!

Oh no, my BP has just shot up thinking about it!

My mother was there for about eight years. At the time we had to put her in there she had dementia and her health had been quite bad after a kidney was removed because of a tumour. Her health improved a lot and she was the only one there not on any medications.

Prior to her kidney operation she had all her faculties at over 80 and put the operation off  for a couple of months as she was going to Canada on her own to visit relatives in Edmonton and Toronto. Another thing one cannot anticipate is the effect of an anasthetic on the brain.