hi, nearly two years ago to the day I had triple bypass. Since then I have been reviewed by cardiologists 3 times and my medication has remained as Atorvastatin, aspirin. I was fortunate as I did not have a cardiac event , and I am currently feeling very fit and well - exercise 4/5 times a week and run 5K 3 times a week…. No angina symptoms at all. However out of the blue yesterday I was contacted by GP and offered Ramipril as this clearly is used to prevent cardiovascular events….. I was weaned off Bisoprolol quite early on after Op as I have naturally low blood pressure….. just a little bewildered as to why now should I be offered Ramipril and am I foolish to decline the option? Do you other post CABG people take Ramipril???
I have asked for cardiologist review but this could take a while.
thanks
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I was put on half a 1.25mg tablet of ramipril.. my pharmacist even questioned its efficacy. I’m on 1.25mg Bisoprolol too, my resting heart rate is 42-44 and consultant says I could try coming off. I think ramipril is BP related and biso heart rate.
thanks for quick reply… so I was weaned off the bisop. As resting HR was low and BP sat around 100/60 on a good day! Can’t understand why GP thinks it’s a good idea now- to be honest it’s unnerved me a little!
It’s difficult to understand , I wished the doctors would give some context ! It worries me that we are treated under a “cookie cutter” regime , one size fits all . I’d definitely want some context. Is your GP familiar with you and your lifestyle ? Seems out of place.
I have had high blood pressure for years and was on three different meds but since I was diagnosed with heart failure and AF last year I was prescribed 10 mg bisoprolol and 7.5 ramipril and my blood pressure is slghtly low but at my review with the Cardioligist the other day he said it was fine and continued with the meds. I also take a statin, digoxin and a blood thinner.
I think I'd want to talk through the medication, if your BP is low already you probably don't want it lowered anymore. If your surgery has a pharmacist, it would probably be worth talking to him/her. I know my own GP has suggested something for me but pharmacist has said, not a good idea, this would be better! I've also found they have more time to talk through things and listen to my concerns.
the replies you’ve had been, in my view, great. What I would add is that the person I would talk to in your circumstances would be the pharmacist employed by my doc’s group of surgeries.
That person can talk it over with you - they are the experts on medications, their inter-actions and so forth.
Unlike you, I did have a cardiac event (STEMI), out of the blue, with minor atheroma. A stent fitted for 100% blockage to LAD, and then the usual cocktail of meds (aspirin, Ticagrelor, Atorvastatin, Bisoprolol, Ramipril).
I have fairly low blood pressure (typically 100/60 before I take the pills) and the betablocker and ACE inhibitor both lower it further - even on the lowest dose of 1.25mg it’s taken me 3 months to be able to function on them . The Bisoprolol was stopped by the cardiac rehab nurse in the first couple of weeks as I was dizzy/freezing cold for 3 hours after each pill, but the cardiologist insisted I went back on it, taking it in the mornings, and wanted to increase the evening ACE inhibitor but didn’t.
I had a follow-up appointment with that cardiologist last week (4 months after STEMI). I was hoping some medications could be reduced, but he said I should stay on all but Ticagrelor for life. He actually still wanted to increase the Ramipril but agreed not to due my low blood pressure. He talked of it as a bit of a wonder drug for hearts, not just relaxing artery walls, and despite almost full recovery of my ejection fraction now, that could reverse if I stopped the Bisoprolol and Ramipril. And I’m supposed to just put up with the fact that I’m tired all the time.
By the way, Bisoprolol is a heart-specific beta blocker, so reduces the effect of adrenaline in the heart, slowing heart rate, and as a consequence lowering blood pressure. Ramipril is an ACE inhibitor (angiotensin-converting enzyme), which reduces contraction of the muscle in artery walls, so widening blood vessels, and reduces blood pressure in that way.
But GPs vary hugely in their heart medication knowledge - my GP suggested stopping Ramipril 2 weeks after the heart attack, indicating he knew less than I did about the benefits of it as my heart was recovering - so do your research, and try and get a cardiologist opinion if possible.
And everyone reacts differently to the doses. My daily 1.25mg might be imperceptible to someone else, but makes a significant impact on me.
I also am on ticagrelor-90mg. I was wondering how much is your out of packet cost for this rx. I just paid, in the U.S., $50 (€48.50)for a 30 day supply (60 pills). Only the Brand name (Brilinta) is sold in U.S.
I’m very glad I’m no longer living in North America! In the UK, so I have an annual prescription certificate since my heart attack, and all 5 medications I’m taking are costing me a total of just £114.50 for the 12 months (about US$140).
Way back in 2015 following a Cardiac arrest, STEMI and stents I left hospital with the usual bag of medication- Ticagrelor, Aspirin, Atorvostatin and Ramipril.
On my first blood test my kidney function had seriously deteriorated. Since in most people Ramapril is supposed to be protective of the kidneys, my GP increased the dose. But on my next blood test it had got markedly worse.
Apparently in some people, and unfortunately I am one of them, Ramapril can cause kidney failure.
As soon as I stopped taking them, my kidney function stabilised and has since then improved very slightly to CKD 3 b.
So, ten years later, aged 75, I am otherwise fine. Still taking aspirin and 20 mg of atorvostatin but living a pretty normal lifestyle.
I’m still on ramipril and will be for life. My cardiologist said that it helps the damaged heart muscle/scar that I have from the stemi and cardiac arrest to not become stiff this in turn improves the pumping ability of the heart. I’m only on 2.5 but am always advised to take it going to bed because of low blood pressure.
I’m also on 5mg of bisoprolol to help protect the heart and as I’ve been left with a few arrhythmia’s because of where the damaged heart muscle is. I split this into 2 doses morning and night as my blood pressure went too low ( 70/40) when I took it in one dose.
Gave me very bad leg spasms, took 1 year to get back to normal, but are bodies cope with things different ways , and our routines vary as we all have different habits. Listen to your body, and your gut feeling.
You are owed an explanation as to why your GP thinks this is necessary. Ever since I first required medication, I have made sure that I have had a full explanation of what each medication does and why it is necessary. Unfortunately, communication is not one of the strengths of the NHS.
It’s your body, if you don’t think it’s a good idea then just say no, even when you do decide to take the med do your own research, read the leaflet insert, have a look online at other people’s experience of the med and if you don’t like the look of it say no thanks, in my experience negotiating with GPs they don’t tell you off for not taking the meds, sometimes the side effects are just too much to cope with.
Hello, I have a similar health profile to yours in terms of naturally low blood pressure (110/65 +/- 3), exercise levels and having had a triple bypass. Although, in contrast to you, I'm only coming up to 11 months post-operation.
Over the first 6 months post-op, I was gradually weaned off 2 of the 3 blood pressure/heart rate meds. At the end of this weaning off period, my cardiac nurse suggested Ramipril be added to my meds.
I think the she did this because, during the rehabilitation discharge appointment, I had drawn her attention to the fact that my hospital notes mentioned a degree of hypertrophy in my heart's left ventricle and a degree of stiffness on the wall of my heart.
Do your hospital discharge notes mention these things or something else relating to the structure of your heart? The stiffness in my heart muscle was flagged up - as inferolateral hypokinesis - in the echocardiogram section and hypertrophy was mentioned in the 'Findings' section regarding the operation.
Ironically, I only flagged up the hypertrophy issue because I was mystified by the surgeon's comment that my left ventricle was 'good with hypertrophy'. And I only mentioned the stiffness in my heart because I was trying to get some clarification about whether the issue was particularly serious given there was no indication in the notes whether it was a minor, moderate or severe issue.
Being an optimist, I was hoping the nurse would say, "When it's only minor, they don't mention the degree of severity!"
I'm guessing that the nurse probably checked with her team's cardiologist who would have recommended Ramipril because it helps with remodelling the heart and helps it return to a more normal size and degree of flexibility.
Hope you can shed some light on why you have been offered Ramipril.
In my case, neither my GP nor cardiologist considered that the benefits of Ramipril would outweigh the drawbacks. (I had collapsed once and, another time, I nearly fell down backwards on a staircase when I was on higher amounts of anti-hypertensives in the 1st 6 months post-op).
Hi I had my bypass in 2022 and am on bisoprolol 2.5 mg in the morning along with my aspirin and Ramipril 5mg in the evening along with my atorvastatin 80mg in the evening
I do lots of walking at a good pace ( no running as back op 14 years ago )
Well done you 👏 I’m sure your cardiologist will advise
Hi. Yes i take 5mg ramipril for my blood pressure at night. I used to take it before my bypass op as well. I also take 5mg of felodopine a in the morning as well.
thank you everyone for comments. I spoke to pharmacist today she too couldn’t see a clear reason for prescribing to me at this stage. I think Gp probably hadn’t read my notes and was taking a ‘ belt and braces’ approach. I’ll get an appointment to talk to cardiologist and go from there….
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