Perindopril and anaemia

[muddlemand]

I'm asking for anti-GP ammunition again or maybe not anti, but I want to be well armed before I go in with my request.

I've just seen that anaemia is a possible side effect of Perindopril. It's one of the rare ones but, according to WebMD, if it does occur it's usually severe.

I was started on Perindopril for blood pressure 10-12 years ago. I never, ever used to have a problem with anaemia even after childbirth/pregnancy loss etc, my levels were always average to high. In the last several years my ferritin has been lower every year, and is now a problem without a treatment that works for me. I don't know how many years this trend has been but at least 6 or 7.

Because of the timing, it's possible that Perindopril is the cause. I'm going to get onto my GP and ask to try coming off it (which in a case study I found, solved the anaemia within a week). But what are they likely to want to give me instead? I'd like to be forewarned and fore-armed! Definitely don't want beta blockers or anything. I have a vague memory of being on one briefly which caused problems - back when I was very ill and not taking much notice, so I'm not sure.

Alternatively I'm considering just coming off the Perindopril and finding out if it helps the anaemia before telling the docs. I monitor my own b/p so if it shot up, I'd ask then. I have read that it's usually ok to stop cold turkey, but I would taper off anyway, just in case of a b/p spike (rebound hypertension) as I think i've heard that b/p fluctuating is more dangerous than when it's high per se. (Annoying to read that stopping abruptly isn't usually dangerous, when I've always been told it's a terrible risk, but I haven't checked sources that say it's safe so I won't judge... yet. )

Personally I'm not worried about my b/p and I'm not worried if it goes up either, having read a lot about this and am almost sure it isn't a problem until it's ridiculously high (reading Malcolm Kendrick mainly). But I don't feel up to having that argument, so if I can keep it borderline to shut them up, that's ok.

I'm struggling this year, eating as much liver and greens as I can(!) and taking the prescribed iron only occasionally when I really can't not, because I don't tolerate it.

Gynae or bowel bleeding have been ruled out. If treatment was working, or the iron wasn't causing big problems, I'd ignore this - you choose your battles! But it isn't working so fingers crossed the Perindopril is the answer, if only I can manage without it.

PS. I know this isn't strictly thyroid-related, but here is where the knowledgeable people are.

[humanbean]

I can't help you with recommendations for meds for high blood pressure, but wanted to comment on a couple of things.

I read your very first post where you mentioned your history of multiple strokes. This could make it risky for you if your blood pressure gets even slightly high before you see a doctor for a different medication.

Your thyroid history is a very fluctuating one, which is probably a factor in your blood pressure woes. You should read this page :

stopthethyroidmadness.com/b...

If you want to read up about alternatives to Perindopril then these links should help - apart from reading the main text on the link click on the drug name links on the right hand side of the page :

bnf.nice.org.uk/treatment-s...

bnf.nice.org.uk/drug/perind...

bnf.nice.org.uk/drug/perind...

bnf.nice.org.uk/drug/perind...

The last three links above are all forms of Perindopril, but I don't know which one you are on.

[muddlemand in reply to humanbean]

Thanks for going to this trouble, humanbean

I shall look at those links - tomorrow, as I took a dose of iron today and am reacting worse than ever! Definitely pouring it down the sink now.

That's also why I'm not up to discussing the whole blood pressure question but don't worry, I'm not going to take risks unless what I learn convinces me that it's a red herring. What I've seen makes sense but I take all health decisions slowly and cautiously.

Is it you that reminds people there can be a thyroid problem even with normal antibodies? That's another line of research for me but one thing at a time.

[humanbean in reply to muddlemand]

It's usually greygoose that mentions that thyroid problems can occur without antibodies.

[greygoose in reply to muddlemand]

Most certainly you can have a thyroid problem with normal antibodies. There are many causes of hypothyroidism. What I'm in the habit of saying is that you can still have Hashi's, even if the antibodies are low. It annoys me when doctors say they're 'ruled out Hashi's', because that's a difficult thing to do, and one negative test of one antibody means nothing. What constitutes hypothyroidism is not high antibodies, but low thyroid hormones - FT4 and FT3.

If you've been reading Dr Kendrick then you surely know that high blood pressure is not a disease, it's a symptom. And, it can very well be a symptom of hypothyroidism. It certainly was for me. Does the Pernindopril work for you? If not, then your high blood pressure probably is a hypo symptom.

Be careful with the liver, it contains a lot of vit A, and you don't want too much of that! And, make sure you always have a source of vit C with it. Have you tried taking iron tablets with vit C?

[muddlemand in reply to greygoose]

Thank you greygoose - symptom not disease is why I'm no longer very worried about my b/p which has never been worse than borderline (except in one pregnancy).

It's an odd thing, it changed suddenly when I was in my twenties and has been more or less stable ever since. After I had my first child at the age of 26, I was overseas for two years without having my b/p checked at all. Before (checked annually at the diabetic clinic) it was always around 70 diastolic, including during that pregnancy. (In those days they only cared about the diastolic, but from memory the systolic was always around 130-140, I think.) After that two-year break, it was 90 plus or minus one or two.

I said quite a lot about "not normal for me" but in those days 90 was the cut-off for worrying and they didn't worry. My second pregnancy, the b/p kept going up and caused problems - I'm inclined to think the problems were caused more by interventions they insisted on than the b/p, but too late to argue about that now... And I tend to think the b/p was mostly about stress as I had undiagnosed PTSD from the first childbirth, which I didn't realise for another few years.

At some point the goalposts moved and they wanted it below 80 for diabetics and I was put on methyldopa. Not sure when but I think 1999 when I wanted to get pregnant again, and they picked methyldopa as it was ok in pregnancy. Third pregnancy, no particular problem with b/p, only with keeping them off my back as I was thoroughly "high risk" according to their tickboxes.

I *think* I stayed on the methyldopa until 2006 when they changed everything after the stroke. Maybe 2001 when I moved and changed GPs.

As for thyroid symptoms, there's so much overlap with other conditions! The only ones I think can be only thyroid-related (as far as I know) are body hair and sweat. I never was hairy compared with other women, all my life, and I'm gradually less hairy over the years. After the second baby I noticed I was hairier and more likely to sweat than before, and these went back to my norm after the third one. Periods became regular after the third, which they'd never been in my life before. Other candidate symptoms such as fatigue, well, I have a whole list of things they could be part of.

Looks like Hashimoto's of the "camouflaged" kind needs to be my next line of enquiry - but I can't see me following this up until next year sometime. Besides, I'd have to get tested privately and then pay for my own treatment, wouldn't I? I can't begin to afford that - I can save up for tests, but can't take on ongoing costs. I may have to stick to treating symptoms as best possible and forget about the rest until - at least until I can move to somewhere cheaper to run (heating etc). Which will be ages as moving is a major challenge, but it is my current long-term project.

[muddlemand in reply to muddlemand]

PS. Since learning about sitting still for 5 minutes before testing b/p, to I'm comparing like with like over different days' tests, my b/p has been down to 130/70 ish, easily. I've also eaten salt as much as I feel like and been taking Vitamin D all year, so the body isn't working so hard (esp. the Vit D has made a huge difference). I'm almost confident about cutting the Perindopril cautiously and gradually, given that from this point, it has room to go up quite a bit before they call it worrying. Previously it was always (the last few years) around 140-160 over 86-99.

[muddlemand in reply to muddlemand]

PPS. I have a pound or less of liver each week - that's as much as I can stand - over two or three meals. Often kidneys too as I like them better. But also I forget, and go a couple of weeks without, and really feel the difference after I "dose up" again.

[greygoose in reply to muddlemand]

Well, that is rather a lot of liver. But, I can't remember how much SeasideSusie said is ok to eat. Maybe she'll cut in and tell us.

[SeasideSusie Remembering in reply to muddlemand]

Liver should be limited to 200g (7oz) per week due to it's high Vit A content.

Nutritional facts about kidneys and liver here

livestrong.com/article/3040...

[muddlemand in reply to SeasideSusie]

Well I'm glad I mentioned it! Thank you.