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Old 07-19-2005, 06:26 PM   #1
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Any input on Thiazide Lisinopril combo?

Greetings,

Without BP meds, my average is 150s over 95 to 98. On a thiazide alone, my BP is 140s over 85 to 90. If I ADD as little as 2.5 mg. per day of lisinopril, my BP is 135 over mid 70s to low 80s. Anyone know why the combo is so effective? Also, is it better to take together, or seperately? Is a combo pill preferable? I am due to refill so I'd like to know how to "advise" the Doc....

Thanks, Brenden.

 
Old 07-20-2005, 06:32 AM   #2
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Re: Any input on Thiazide Lisinopril combo?

The combo is particularly effective for the following reason. When you take a diuretic to deplete your body of sodium and water, your kidneys produce the hormone RENIN which causes the eventuual production of Angiotensin-2 a very potent pressor (raises BP) agent. Among other things, angiotensin squeezed down on small arterioles to raise BP, thus battling the effects of the diuretics.
So an ACE inhibitor stops the conversion of angiotensin to angiotensin-2 and prevents the feedback allowing the BP to stay down.

The reverse feedback happens with just the ACEI because more aldosterone is produced by the adrenals and sodium is retained and thus the effect of the relaxed arterioles and lowered BP is countebalanced by water retention and higher BP. The thiazide (or severe salt restricition) prevents the feedback loop!

I would go so far as to say "you can't have one without the other" and in a less tuneful way that these two drugs are really ideal mates for those people who don't have a lot of luck with severe salt restricted diets. That's why there are so many ACEI-HCTZ combos. I wish I could take an ACEI but alas, THE COUGH!

Last edited by Lenin; 07-20-2005 at 06:49 AM.

 
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Old 07-20-2005, 07:20 AM   #3
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Re: Any input on Thiazide Lisinopril combo?

Quote:
Originally Posted by Lenin
The reverse feedback happens with just the ACEI because more aldosterone is produced by the adrenals and sodium is retained and thus the effect of the relaxed arterioles and lowered BP is countebalanced by water retention and higher BP. The thiazide (or severe salt restricition) prevents the feedback loop!
This sounds backwards to me. Angiotensin II stimulates the adrenals to produce aldosterone. An ACEI reduces angiotensin II levels. Thus, the level of aldosterone is going to be lowered not raised as you indicated. And, a lowered aldosterone level is going to result in less sodium retention. So, the ACEI will have a mild diuretic property all by itself.

Pal

 
Old 07-22-2005, 08:26 AM   #4
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Re: Any input on Thiazide Lisinopril combo?

I don't know how it works, but when my mother was on lisinopril/hctz, her bp was the best it had ever been. Then she became allergic to it over the yrs, and her dr put her on something else. He bp hasn't been the same since.

 
Old 07-22-2005, 09:59 AM   #5
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Re: Any input on Thiazide Lisinopril combo?

There are lots of combo pills and have the advantage that you only have to take one pill instead of two. On the other hand, I like to be able to adjust the quantity of each drug separately if I feel the need to "tweak". Doctors don't like patients adjusting their own meds though.

 
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