Ace inhibitors and arb

medicinenet.com/arbsace_inh...

I have been on lisinopril for about a year now and was put up to 25mg. Now I have had a few niggles with what I believe are side effects, especially from sitting to standing which produces dizziness. Now I know good old Google is not really the best place to search but there are some useful information. The trouble with many medications, they are good for one thing but then cause other issue's. I have found that lisinopril has definitely helped my blood pressure. But am I on too much? I carnt answer that and have to go along with the doctors and specialists. However when I did ask if I could cut down I was told that lisinopril was also helping the pumping of the heart. So can I live with the side effects,? So I wanted to know what other benefits there where to try and alow my mind and body to except that I have some small pain the have more gain. Any way I found a link which is above which did show that these medications do seem to help with other functions of the body and heart.

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I think that is quite wise. I have noticed that since doing more gym work and the occasional walking. The blood pressure does naturally come down so I could have a double wamy of medication bringing blood pressure down and exercise. Also healthy eating and drinking more water. Increase in water intake can help raise blood pressure. So it become a balancing act. I do hope that I can reduce my medication in time but we will have to see. But I know that I will be on some sort of medication for life to help my right ventrical. Of cause the jury is out on wether ace inhibitors can help the right side of the heart. But it does help the left side because that is where all the investment and knowledge has been ploughed into. I just hope they start to move more medical interest into the right side of the heart. Thanks for the reply

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Yes it does baffle me. Why the right side is not looked into more. Like with my congenital issue it was found in 1864. You think that's was enough time? Any way I do hope that ace inhibitors and arbs do have some effect on the right side. You would think so but its more complicated than that. It seems the right side is manufactured at a different time to left side when we as humans are being formed. But the right side is quite important as it sends blood to the lungs to pick up oxygen. And we need oxygen to live. Trouble with the right side it is a low pressure side so it can be a bit more tricky to work on or research. But as I say you have to trust the experts. They know best. So I will keep taking the tablets.

[MountainGoat52]

I think ACE inhibitors are often the first port of call for treating blood pressure. I was initially put on Ramipril and got the dreaded cough, but following blood tests relating to my kidneys I was changed to Amolodipine, a Calcium channel blocker. That gave me painful oedema in my lower legs, so I was prescribed Losartan an ARB which suited me and I've now been on this for over 12 years.

All three classes of medication have, from time to time, given me the dizziness when standing after sitting, particulary after sitting a while. Our blood pressure naturally drops when we stand up and I guess as we age the response time to achieve equilibrium gets longer. I now have the added bonus of being on Nifedipine for Raynauds, so I take extra care when standing up. Being on Bisoprolol doesn't help either as my pulse is often in the 40s when sat relaxing and I'm slow "coming out of the blocks". 😁

[Hidden in reply to MountainGoat52]

I have to admit I have not had the cough yet. But the intriguing thing is they first put me on losartan but was quickly changed to lisinopril? I don't know why never really asked. Only thing they said was they do similar jobs. But it might be something I may ask one day. But the dizzy Ness is the worst bit. But I have split tablets and take half in morning half at night. I did get permission from doctor but it seems a bit better.

[MountainGoat52 in reply to Hidden]

I would think the change to Lisinopril was purely because of the preferences at your GP practice. I note from the NHS drug tariff for this month the cost of 10mg Lisinopril is about spot on that of 50mg Losartan, so cost is unlikely to be a factor. With regards to the cough, well that is a Ramipril thing, not Lisinopril as far as I know.

I think splitting tablets is a very good idea in your situation. Of course some medication is specified for consumption at certain times, for example my Losartan is to be taken in the morning. No-one has ever told me that, it just appeared on my prescription a few months back. Not as though it concerns me as all mine get consumed with breakfast except for the second and third Nifedipine tablets which I take with lunch and evening meal. I'd prefer one dose a day, but for some reason it is a 3 x 5mg dose each day. I'm still getting used to it!

[Hidden in reply to MountainGoat52]

It was the cardiologist who wished it be changed. So they must know the difference in the way these medications effect the heart and the associated blood vessels. But if that is what has to be done then we have to go with it. Thank for your detailed reply. Just wonder which one has less side effects. Lisinopril or losartan.

[MountainGoat52 in reply to Hidden]

The cardiologist will have known the details of your situation which will no doubt have affected the choice of medication. I was put on the ACE inhibitor first so the class of mefication might generally be the preferred choice. As for side effects, I think neither medication has major issues, though it depends on the individual of course. I have serious issues with PPIs and diuretics whereas many people have no issues at all.

[Hidden in reply to MountainGoat52]

Yes I suppose they prefer certain meds for the condition. I have to admit the lisinopril has definitely brought down my blood pressure. The only problem I have is with that and the combination of spironolactone a diuretic my potassium went up to 5.9 so I reduced the spironolactone to half tablet 12.5 mg and within a week it came down to 4.5 but both lisinopril and spironolactone can effect potassium. So it becomes a balancing act. So the next question I might have to ask is to control potassium should I increase spironolactone to help to reduce water retention, which I don't have at present but does it help with oxygen transfer, and instead reduce lisinopril? Iam waiting for a cpet test which is not urgent but that was the test that told them I needed spironolactone. I am hoping for the cpet test soon. Since my last cpet test in July last year I have been doing more gym work and this may be naturally assisting with blood pressure reduction. Trying to loose weight. That's the hardest one but i have come down from 90kg to around 84kg would like 80kg so thats my goal.

[MountainGoat52 in reply to Hidden]

Ah, the dreaded balancing act. It sounds like you need a prescription for sandpaper to rub at bit off one of your tablets. At 5.9 mmol/L you are on the borderline of hyperkalemia. I think my latest reading was around 4.8 mmol/L. At the other end of the scale I've had some hypokalemia episodes due to loop and thiazide diuretics which made me extremely unwell. PPIs also trash my potassium with similar though less dramatic effect.

It's amazing how the treatment for one aspect of your health can affect another, yet can we get someone to look at the whole picture? Everyone seems to be a specialist in their own field, blinkered to other areas of expertise. GPs only seem to be able to think of one aspect of your health at any one instance. I guess this is where Pharmacists come in. I've certainly found the Pharmacist at my GP practice very helpful, indeed my GP passed me over to her rather than try to sort my medication out. Maybe that's the way it is going.

All the best with getting your weight down. As they say, every little helps. My weight dropped when I had my heart attack as the stents that were inserted improved my cardio-vascular system which in turn improved my digestive system. I took off 7kg in a week. However I can't say I can recommend a heart attack as a method of reducing your weight. 😯

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I think I will try not to have a heart attack to reduce weight. However I have done some more investigations and talked to my cardiac nurses. And the lisinopril is the most important medication and I will stay on half tablet of spironolactone. The one issue I did get when my potassium went up was more ectopics. But I think I made it worse by having bananas and a lovely creamy Indian curry with coconut milk in. Oh well live and learn. But the potassium was slowly going up any way but it just shows how you have to watch what you eat., but I suppose I have to realise at the moment that iam only taking two different tablets for my condition. Many people have to take loads of tablets in one day for their conditions. I agree with your statement that the medical people will specialise in their field but don't have an interest in the other fields. So for example mental health, you have had a shock to the system and they fix you up and send you on your way but how do they know that the tablets they give you can then cause things to happen to then effect mental health issues. Or you get more muscular problems brought on by the medication. But you need the medication to help your heart. So you end up on other medication to stop or remove the side effects. It does become a mine field. It's been nice talking to you as you gave me the confidence to send email to my cardiac nurses.