Need an operation

[Garbarek]

I need an operation for a joint replacement but my blood pressure is too high. I am taking Ramipril 10mg at the moment. Desperate to bring my blood pressure down.

[MichaelJH Heart Star]

Hello and welcome to the forum!

Unfortunately you have given so little background so I can only generalise.

A healthy lifestyle is important taking in diet, exercise, etc. Having an arthritic hip I appreciate exercise may be limited.

You are currently on the maximum dose of Ramapril. An increasingly common approach is dual therapy which combines two different medications with different actions. Ramapril is an ACE Inhibitor. I am on a low dose of Lisinopril (another ACE Inhibitor) and minimum dose of Bisoprolol (a beta blocker).

You need to contact your GP. If necessary he can refer you to a hypertension consultant if appropriate. Obviously any underlying health issues need to be taken into consideration. Good luck!

[Garbarek in reply to MichaelJH]

Thank you Michael. I am seeing a nurse at the heath centre tomorrow so hopefully she will have suggestions. I live a health lifestyle, though at present exercice is limited, don't smoke, drink little , eat a healthy, largely vegetarian lifestyle. I do get stressed but trying breathing exercises. I had a stent at the end of 2018, which was a complete shock - it followed a collapse and investigations. Hope the bp can be sorted as I won't the hip replacement to get on with my life (already had one). Anything I can do to try to improve my general health I am happy to try.

[MichaelJH Heart Star in reply to Garbarek]

Another advantage of dual therapy is that typical lower doses are required. Increasing doses of the same medication can cause a person to develop a degree of resistance to the drug. When my statin was quadrupled post bypass my cholesterol hardly changed. If the nurse is not familiar with dual therapy ask to speak to the doctor. You are in the maximum dose Ramapril so it seems highly appropriate.

Please bear in mind I am not medically qualified but have at various times been on all the different types of BP medication. Good luck tomorrow.

[Garbarek in reply to MichaelJH]

Once again, thanks Michael. It is quite hard getting to see a doctor in the practice I attend - they are very under-resourced in terms of staff but I will will follow your advice and ask to see her.

[MichaelJH Heart Star in reply to Garbarek]

In the current climate an initial telephone consultation should be fine.

[Chappychap]

Following a heart bypass operation at the end of 2018 I resolved to make some significant improvements to a range of key health metrics, including blood pressure.

I monitored my blood pressure every day and found it fell in three distinct stages, which broadly aligned with the following three changes that I made,

1. Taking the prescribed medication, in my case there are two which have an effect on blood pressure. The ACE inhibitor "Ramipril" and the Beta Blocker "Bisoprolol".

2. Exercise and a Mediterranean diet, I commenced these two together so I can't say which was most important. I also subsequently lost nearly two stone, but I clearly saw a drop in blood pressure very early in the weight loss process.

3. Reducing salt intake. This was probably the simplest change of all, but the impact on blood pressure was dramatic. The maximum recommended daily salt intake is 6g (2.5g sodium), but I average about half this. Every time my salt intake goes up (as inevitably happens for example if I occasionally have take way foods even in extremely moderate quantities) I can see an immediate effect on both my weight (water retention) and blood pressure (increased salt).

Good luck!

[Garbarek in reply to Chappychap]

Thanks Chappychap. I have started monitoring my blood pressure regularly and it fluctuates a lot. Two weeks ago I had a 24 hour BP monitor from the medical centre and again it fluctuated.

I can't wait to be able to get more exercise - roll on hip replacement..

Tomorrow at the health centre they are testing my kidney functioning as my sodium is low - use little in cooking.

I am being as positive as I can and the helpful advice I have been offered on this page so far helps.

[Ianc2 in reply to Garbarek]

If you are desperate to get you BP down you can try the 800+ diet. You can find a lot of information about it on diabetes.org and cookbooks are available . It is aimed at diabetics, with the intention of of reducing weight rapidly. Lots of green stuff, virtually no carbs and some protein. It does work but requires a lot of dedication to make it happen.

I know 2 people who have gone down this route to avoid the ravages of diabetes, transforming their weight and their blood pressure along the way. One is happily out playing golf, and back on a normal diet His doctor showed him pictures of amputated limbs and explained how his eyesight would suffer. Shocked him and his wife rigid. Major changes were made.

The other was doing really well. Her weight was coming down, she was taking exercise and the change in blood pressure came as a pleasant surprise. She suffered a relapse after the death of a grandchild and started comfort eating, her weight piled back on amazingly quickly and her blood pressure went back up. She is now walking with a walking frame and is now climbing back onto the diet, feeling very sorry that all her good work has been wasted

It is not a long term diet but is probably worth discussing with your Doctor in order to achieve a short term target. It will also take you into the middle or lower level of your BMI range which will help with the pressure on your hips.. If you can get any exercise using walking poles , along level paths, it will help.

[Garbarek in reply to Ianc2]

Thank you. I will research the diet - sounds a good idea. I eat a lot of salad and fruit.

[tunybgur]

Hi Garbarek,

You don't say how old you are.....Ramipril is less effective if you're over 55.

I'm 72 and recently stopped 7.5mg of Ramipril due to concerns over Coronavirus, it made virtually no difference to my BP.

[Garbarek in reply to tunybgur]

Thank you. I am 67 - I will bring this up when I visit the health centre today.

[Routemaster in reply to tunybgur]

Were you told to stop taking it by your doctor, because the studies I have read say that taking the drug and the virus was fake news? My cardiologist said that it was important to continue taking it!

[Garbarek in reply to Routemaster]

No, I haven't been told to stop taking it.

[tunybgur in reply to Routemaster]

My GP said it was my decision but he recommended I keep taking it.

It was the article in the Lancet that recommended changing from Ace inhibitors to calcium channel blockers that made me stop. This has been followed up with another article that basically says we don't know enough, but probably better to keep taking them which is the opinion of most of the medical profession.

I still don't take them for three reasons, I'm already on a CCB, my BP hasn't gone up at all and my cough has gone.

Link to Lancet articles below:

thelancet.com/pdfs/journals...

thelancet.com/pdfs/journals...

[Routemaster in reply to tunybgur]

Interesting but I will keep taking the medication as it seems to keep me well!

What I think this virus has shown is how so many scientists and doctors have different ideas about prevention, causes and treatments. We still have so much to learn about diseases.

[Garbarek]

I will read the articles. Thanks.

[MichaelJH Heart Star in reply to Garbarek]

The BHF response is in this article:

bhf.org.uk/informationsuppo...

[tunybgur in reply to MichaelJH]

Yes I have read this and totally understand the concern if everyone stopped taking their Ace inhibitors.

I didn't take any notice of the tabloid stories, but was certainly interested in the Lancet article, their later addition to this story not rescinding it but saying we needed more research.

I was also interested to read the statistics from the Italian outbreak. 73% of people dying from Covid-19 in Italy had hypertension listed as their pre-existing health condition. The ONS study doesn't have this as a category, but I assume many if not most of these people were on Ace inhibitors or ARB's.

Well I made my decision and fortunately my BP is not unduly high, ave 125/70.

Good luck

[MichaelJH Heart Star in reply to tunybgur]

Nothing to worry about with your BP. When I stopped Amlodipine (a CCI) because of odema my BP stayed the same. We all react differently which why getting medication right is so tricky. I must admit a slight bias. ACE Inhibitors help protect the kidneys in the presence of diabetes which is why they are usually the first BP medication prescribed for diabetics.

I did see an article that said a lot of the deaths in China were only diagnosed with hypertension and/or diabetes on admission to hospital. Nothing is ever simple!