To take Ramipril - or not - that is the question?

[Maxspencer]

Hi All,

I'm fairly new but must say that I'm impressed with this forum. It seems like almost everyone on here is constructive and supportive and it's a brilliant place to visit when your health issues get you a little down.

Last July (at age 55) I went in for an angiogram after having some strange chest symptoms on exercise - not exactly pain and no short breath but definitely discomfort. Prior to this I had undergone a CT angiogram (indicated some plaque deposits but zero stenosis of heart blood vessels), and a Nuclear Stress Test (nothing conclusive but a possible blood supply problem or could just be my diaphragm or fatty deposits in way ).

So I went into the angiogram expecting all to be well and came out with a stent for a completely blocked vessel. Quite a shock! I'm doing everything I can to get back on with my life but prior to the chest symptoms I'd been trying to ween myself off statins (taken for raised cholesterol) as I'm not a big fan of the many side effects.

Anyway, as you can guess, I never managed to drop the statins in the end! So now my cardiologist - great chap and best bedside manner of any doctor I've ever encountered - says on top of the statins (plus aspirin, clopidogrel and magnesium for ectopic beats) I ought to be taking Ramipril too. Having read much about this and assuming that I should be in pretty good health after the stent (no other narrowing of vessels found during angiogram) I'm not keen to start on something that I know a lot of people don't get on with and is riddled with possible side effects.

I'm trying to eat well - cutting out the bad stuff, get lots of exercise and taking a couple of supplements (super garlic, Co Enzyme Q10). It just seems that I've gone from trying to reduce my medication to taking on loads more. Isn't Ramipril usually taken if a person has suffered a heart attack?

My wife tells me I should stop procrastinating and start taking it, but I'm still reluctant. What are everyone's thoughts on the need to add Ramipril to my drug regime?

All opinions welcomed and appreciated.

[NorthantsSteve]

Hi

Ramipril is an ACE (angiotensin-converting-enzyme) inhibitor that lowers blood pressure. Common side effects include dry cough, dizziness, headaches etc. With your beta blocker it’s designed to get your heart beating as slow as possible to reduce the load on your heart to reduce the risk of heart attack. The Docs try to increase these meds so that your heart gets the maximum benefit and it’s usual to take these following an angiogram/stent.

I’ve been on them since I had my heart attack two years ago (this came out of the blue with no prior symptoms) and haven’t had any side effects that I can report. Like you, I’m not a fan of taking medication, but have become resigned to the fact that I need to follow this regime in order to prevent a future incident.

Hope that helps.

[Maxspencer in reply to NorthantsSteve]

Thanks for this Steve. I never mentioned that I already have a relatively slow heartbeat 40-50 at rest and 120/80 blood pressure. I’m not on beta blockers. I think you might well be right and I should probably buckle and just do as I am advised but it’s good to hear it from someone who has already made that decision. I hope that you are keeping well after what must have been a shock a thousand times worse than mine.

[NorthantsSteve in reply to Maxspencer]

Thanks, Max. I was 55, too when I had my HA. In fact all of us on the ICU unit were 55. Must be an unlucky age for dodgy hearts. I’m not sure that my experience was a thousand times worse than yours. My heart damage was minimal and I think it presses home how close it was. And that shapes my approach to taking the meds as well as eating sensibly and exercising. I’m grateful that I got the opportunity to continue for a bit longer! Two years on and I’ve never felt better. And I’m determined to have many more years. If the downside is a few minor side effects then I’ll live with it. I guess if they were serious I’d rethink that one.

[Kristin1812 Heart Star]

Hi Max. I take everything I’m told to! But Ramipril caused a very annoying cough and they found a substitute.

I’m now doing well.

I hope it’s the same for you

[Maxspencer in reply to Kristin1812]

Hi Kristin, it seems that many suffer a similar effect. I already don’t sleep particularly well and the thought of adding a dry cough to the equation isn’t making the decision easier. Like you say, I can always switch to an alternative. I think it is the thought of taking so many different drugs that I have the biggest problem with. Thanks very much for your thoughts, I think that the consensus that is developing here will tip me into giving it a try.

[Kristin1812 Heart Star in reply to Maxspencer]

You’re right. The whole thing is such a shock, one that certainly took me a long time to come to terms with. I think it kind of reminds us, three times a day of our frailty!

[Maxspencer in reply to Kristin1812]

I know Kristin! Still can't believe it. Wouldn't have even had the angina diagnosed in the first place if I hadn't been lugging 30 bags of cement up two flights of stairs. Just carried on through it thinking it couldn't be anything to do with my heart. I have denial down to a fine art and even now the fact that I have a stent seems like a freakish nightmare. I'm in a better place these last couple of weeks and I'm certain reading the stories of many on here - having much bigger shocks and being ten times (or more) braver than me - has made a huge difference to my outlook. A heartfelt thanks to all of you!

[Kristin1812 Heart Star in reply to Maxspencer]

Good on you making such progress. Keep going!

[Pippa1234 in reply to Maxspencer]

There are alternatives to ramipril

[Traveller85]

Yes you should probably take it. If it courses you a cough, it can be switched to s similar medicine.

[Maxspencer in reply to Traveller85]

Thanks Amit, I think you might well be right. I will give myself another week of research/pondering and then get on board the Ramipril Express. I suppose I just figured with an already slow heartbeat and spot on blood pressure it was likely to make my heartbeat too slow and blood pressure too low. Does anyone else think or agree that that might be an issue?

[Traveller85 in reply to Maxspencer]

It can lower your blood pressure, dose dependent, but it does not affect your heart rate.

[Maxspencer in reply to Traveller85]

Thanks Amit, good point indeed. And I guess that's what makes me wonder. I mean, is taking someone's blood pressure below what is considered ideal (i.e. 120/80) a good idea. Surely if that's the most healthy level, shouldn't it be best to keep it there? Is lower than ideal better for the heart so there is less work for it to do? If so what other areas of the body fall into disrepair? The more I find out the more questions arise. More research for the week I think. Thanks again for your thoughts.

[Fortepiano in reply to Maxspencer]

From the NHS website on blood pressure:

'ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg'

nhs.uk/common-health-questi...

[Maxspencer in reply to Fortepiano]

Well who'd 'ave thunk it? All these years and I never knew that! Thank you Fortepiano. So there's quite a bit lower I can go without danger plus also this should be taking some strain off the heart. That sound about right?

[Fortepiano in reply to Maxspencer]

Yes, ACE inhibitors like ramipril are excellent drugs and do a lot to protect the heart apart from affecting blood pressure. People think of them as just blood pressure meds but they're much more than that. I've taken ramipril with no problems at all .

My view is the cardiologists are the experts and the medications together with lifestyle changes are both very important parts of preventing progression of heart disease. I appreciate it's hard to suddenly find yourself with a handful of medications but I agree with your wife!

All the best

[Maxspencer in reply to Fortepiano]

Thanks for the useful info. It does make sense. I think I will be going ahead shortly.

[Prada47]

Good point Max I sometimes wonder about lowering blood pressure to much. I was told beta blockers make the Heart Beat Stronger allowing it to push more blood out of the Heart thereby increasing the ejection fraction, a symptom of Heart Failure. One point about lowering blood pressure is I believe a reduction in the risk of a Stroke.

Regards

[Maxspencer in reply to Prada47]

No one has suggested beta blockers for me so far but I do know that my father takes them for his heart failure. It seems that while there are consistencies in what folks are prescribed, there are also some that have one drug and not another. Is this just differences in severity of condition or something else, I wonder?

[Prada47]

Forgot to say Candesartan is normally the alternative to Ramipril should you develop a cough !!

[Maxspencer]

Cool Prada, good to know. I wonder if I'll end up getting the cough because I'm half expecting it. Psychosomatic kind of thing? Thanks for your thoughts on this, by the way.

[Pandorella]

I came upon this page by accident. I have just been prescribed the Ramipril. It is good to hear of other people's opinion. I was diagnosed with Angina beginning of January, but now they found it is not the case. Instead of the Isosorbide tabs they gave me this Ramipril, and a beta blocker, Bisoprolol.

I also wondered why they are trying to lower my Blood Pressure and heart rate when they are already low.

I am new to all this, and I am not sure if I should be active as I used to be. I used to go dancing twice/3 times a week, before all this. I also would like to go swimming but not sure if this is OK to do. How does one finds out about such things? However, I don't feel as energetic as I used to be. Any advice would be most appreciated.

[Maxspencer in reply to Pandorella]

Hi Pandorella, how did they come to find out that it wasn't angina? If not angina then what is it they have diagnosed? To know whether you should be as active as before, more detail of what happened would really help.

I've been on the Ramipril for two weeks now and yesterday went for a blood test (as instructed by doctor) to see how my kidneys are coping with the drug. I wasn't happy about taking it at the start - hence my original post above - and after two weeks I have to say that I haven't felt that great. I can't be sure that the cause is the Ramipril but the timing of my new symptoms does make it seem so. I was exercising an hour a day (daily walk plus exercise bike) and now I've cut out the bike because I don't feel up to it. I'm not sleeping well and I have almost permanent indigestion - not great when my previous indigestion turned out to be angina and required a stent. Also when I wake up in the night I feel very anxious. My wife thinks I should give up the Ramipril (she was the one who said I should bite the bullet, listen to the doctor, and take it in the first place). I have a doctor's appointment in a few days to discuss the results of yesterday's blood test and hopefully that will provide some answers.

Anyway, it seems to me that we all react differently to different drugs and there is certainly a whole heap of experience on this forum to help. Many swear by Ramipril and it does seem after much internet browsing that it has benefits beyond blood pressure management when it comes to elongating heart life and useful function. Like you, my blood pressure (120/80) and heart rate (48 mostly) are not indicators for needing Ramipril.

If you are able to provide a little more information to go on, I'm sure there will be plenty of good folk on here that can help you. Good luck!

[SylviaBerry in reply to Pandorella]

Thats interesting. Im on 1.25 ramipril and 1.25 bisoprolol and Im weak as kitten and good for nothing. I was diagnosed with myocarditis after angiogram last friday. Came home the same night and have only just today managed to do a bit of pottering about. I feel very lightheaded and when I try and sleep Im woken by what feels like a shock and a sudden drop down a roller coaster. My GP has already taken me off ticagrelor because of leg pains and a blood rash. I went to see a duty doctor yesterday who asked me what I thought it was. I said maybe the beta blocker and he said stop taking it then. I havent because I think he just put the ball in my court and my bp is high, so I dont want to risk it. My GP cant do much until the cardio unit at the hosp transfer my inpatient info. A week later and he still has nothing. I dont know if it is the myocarditis or the bp meds making me feel so weak and woozy...or the statin...or my mindset?

[Maxspencer in reply to SylviaBerry]

I'm no doctor but isn't myocarditis a viral condition that should be cured after a few months? I'm not sure of the symptoms but I imagine if you follow your doctor's orders then you will hopefully come out as good as new after it runs its course. As for the ramipril, you said initially that your blood pressure was low and then latterly that it is high so I don't know what to make of that? I do know that after my doctor's appointment to discuss my blood results after being on it for 2 weeks that my body tolerated it just fine. I gave it up anyway because it made me feel bad and I also slept badly. If you do have high BP and it is the ramipril is not agreeing with you (my mindset sucked and I didn't feel right, so this could be the cause in my opinion) , I believe there are quite a few alternatives, and I may be trying one soon myself. As for beta blockers, I couldn't say as I am not on these at present.

Anyway, hopefully your doctor will have more advice for you once he receives your info.

Good luck and please let me know how you get on.

[SylviaBerry]

Hi Max, a bit more delving and I think it could be the bisoprolol as opposed to the ramipril. Its all trial and error I suppose. I agree about mindset too, I tend to be cautious around drugs, but have usually been fine. I think they give us such a cocktail it would be maybe odd if we didnt all have at least some kind of blip. Hope all goes well for you x